CPY 531 LECTURE NOTE

DR NOSA OSAKUE
LIVER DISEASE
• The term “liver disease” refers to any of several conditions that can affect and
damage the liver.
• Over time, liver disease can cause cirrhosis (scarring).
• As more scar tissue replaces healthy liver tissue, the liver can no longer function
properly.
• Left untreated, liver disease can lead to liver failure and liver cancer.
 Causes of Liver Disease
Liver disease generally refers to conditions that damage your liver. They can develop for
many reasons, including:

•Damage from viruses

•Alcohol overuse

•Medication misuse

•Exposure to toxins

•Autoimmune conditions that block the liver's ability to function properly

Depending on the underlying cause, liver disease can typically be managed through
lifestyle changes, medications, and sometimes a liver transplant or surgery. If it's left
untreated, liver disease can cause serious complications that may be life-threatening. 
Hepatitis
• Hepatitis is liver inflammation that can either be caused by a virus or by other factors.
• There are two main categories of hepatitis:
• Viral hepatitis is the most common type of hepatitis. This infection develops after
exposure to viruses through contaminated food, water, or bodily fluids. Vaccines are
available to help prevent infections caused by hepatitis A and hepatitis B viruses.
• Non-viral hepatitis is caused by heavy use of alcohol or drugs, exposure to certain
toxins, and some autoimmune diseases.
• Some hepatitis cases clear up on their own if the body can fight off the infection.
Other cases of hepatitis are "chronic," meaning they last for long periods of time and
often lead to serious health complications.
Fatty Liver Disease
• Fatty liver disease  is just what it sounds like: damage that happens when too much
fat builds up in the liver.
• There are two types of this condition:
• Non-alcoholic fatty liver disease, which is linked to type 2 diabetes, obesity, and an unhealthy
diet.
• Alcoholic fatty liver disease, which is linked to heavy alcohol use.
• Fatty liver disease can typically be treated with lifestyle changes, such as improving
your diet and reducing your alcohol intake.
Autoimmune Conditions
• Autoimmune condition happen when the immune system—the body’s protection
against harmful infections—mistakenly attacks itself. When a person has an
autoimmune liver condition, the liver cells are specifically attacked and damaged.

• Common autoimmune liver conditions include:

• Autoimmune hepatitis

• Primary biliary cirrhosis 

• Primary sclerosing cholangitis

• While these autoimmune conditions share similar symptoms, each one causes
damage in slightly different locations, responds differently to treatment, and is
linked to different risk factors.
Genetic Conditions
• A genetic condition is a health condition that’s passed down by one (or both)
parents. Certain genetic conditions impact the liver and its ability to function
properly, such as:
• Hemochomatosis which causes a buildup of iron in the liver
• Wilson’s disease, which causes a buildup of copper in the liver
• Alpha-1 antitrypsin deficiency, which causes a lack of a vital protein in the body
• Family history of a genetic liver condition isn't always known. Blood testing and
genetic testing can help determine a diagnosis.
Drug-Induced Liver Disease
• Drug-induced liver disease is liver damage caused by an overexposure to certain drugs. Because
the liver helps the body process substances, taking too much of a medication, drug, or supplement
can harm the liver cells.
• Some common drugs that can have this effect on the liver include:
• Tylenol (acetaminophen)
• Epilepsy medications
• High blood pressure medications
• High cholesterol medications 
• Certain antibiotics
• Some supplements, such as anabolic steroids, green tea extract, niacin, and vitamin A 9
• Depending on the drug and the person, liver damage can happen after short-term or long-term
use. This damage can usually be successfully reversed and treated after stopping the drug.
• It’s best to check with a healthcare provider before adding a new supplement to your routine. Even
though they're available over-the-counter, overuse of supplements can lead to liver damage and
other serious health issues or interact with medications you're currently taking.
Cancer
• There are several different types of liver cancer that develop when cells start to grow
abnormally, forming cancerous tumors. 
• Experts are still researching the exact causes of liver cancer, but they’ve identified
several factors that may put a person at an increased risk for developing it, including:
• Viral hepatitis
• Heavy alcohol use
• Smoking
• Exposure to certain toxins or chemicals
• Family history of liver disease
• Medical conditions such as non-alcoholic fatty liver disease, lupus, and diabetes
• It’s also possible for certain cancers to spread from other parts of the body to the
liver, like from the breast, stomach, pancreas, lungs, or kidneys.
Cirrhosis
• Cirrhosis is severe scarring of the liver that happens after long-term damage.
Because this scarring blocks blood flow to the liver, the organ isn’t able to function
properly.
• Cirrhosis is most commonly caused by:
• Heavy alcohol use
• Hepatitis B and C
• Non-alcoholic fatty liver disease
• While there’s no cure for cirrhosis, some steps can be taken to stop the progression
of the disease and heal some of the scarring.
Cancer
• There are several types of liver cancer  that develop when cells start to grow
abnormally, forming cancerous tumors. 
• Experts are still researching the exact causes of liver cancer, but they’ve identified
several factors that may put a person at an increased risk for developing it, including:
• Viral hepatitis
• Heavy alcohol use
• Smoking
• Exposure to certain toxins or chemicals
• Family history of liver disease
• Medical conditions such as non-alcoholic fatty liver disease, lupus, and diabetes
• It’s also possible for certain cancers to spread from other parts of the body to the
liver, like from the breast, stomach, pancreas, lungs, or kidneys.
Cirrhosis
• Cirrhosis is severe scarring of the liver that happens after long-term damage.
Because this scarring blocks blood flow to the liver, the organ isn’t able to function
properly.
• Cirrhosis is most commonly caused by:
• Heavy alcohol use
• Hepatitis B and C
• Non-alcoholic fatty liver disease
• While there’s no cure for cirrhosis, some steps can be taken to stop the progression
of the disease and heal some of the scarring.
Liver Disease Symptoms
• Liver disease doesn’t always come with noticeable symptoms. But when it does,
some of the common signs include:
• Jaundice (yellowing of the eyes and skin)
• Abdominal pain or swelling
• Swelling in the legs and ankles
• Itchy skin
• Dark urine
• Pale stool
• Fatigue
• Nausea or vomiting
• Loss of appetite
• Bruising easily
• Confusion or agitation
• These symptoms may vary depending on the person and the underlying cause of
the liver disease.
Diagnosis Liver Disease
Blood tests: The most common liver tests include:
• Liver enzymes test. Your liver enzymes include alkaline phosphatase (ALP), alanine transaminase
(ALT), aspartate aminotransferase (AST) and gamma-glutamyl transferase (GGT). These are
elevated when there’s liver injury.
• Total protein test. A total protein test measures levels of protein in your blood. Your liver makes
protein, and low protein levels may indicate that your liver isn’t functioning optimally.
• Bilirubin test. Bilirubin is a waste product that your liver deposits in bile.
• LDH test. Lactate dehydrogenase (LDH) is an enzyme found in many of your body’s tissues,
including your liver.
• Prothrombin Time (PT) test. This test measures how long it takes for a sample of your blood to
clot, a process that involves proteins that your liver produces.
Imaging tests: Your provider can use ultrasound, MRI or CT scan to look for signs of damage,
scarring or tumors in your liver. Another specialized type of ultrasound called fibroscan can be used
to determine the degree of scarring and fat deposition in the liver.
Liver biopsy: During a liver biopsy, your provider uses a thin needle to remove a small sample of
liver tissue. They analyze the tissue to look for signs of liver disease.
What do high AST and ALT mean?

• Elevated AST and ALT levels may indicate liver injury.

• These are the enzymes that are most commonly released into your bloodstream
when your liver is stressed.
• If both are elevated equally, it indicates a nonalcoholic type of injury, which
may include infection or other toxins.
• When AST is elevated twice as high as ALT, it indicates alcohol-induced injury.