chronic liver disease cirrhosis hepatic encephalopathy dr. yasir m khayyat mbchb,frcpc,facp,abim...

Chronic liver disease Cirrhosis

hepatic Encephalopathy

Dr . Yasir M Khayyat MBcHB,FRCPC,FACP,ABIM

Assistant professor of Medicine

Faculty of Medicine

Umm AlQura University

• Chronic Liver disease …?• Does this means there is acute liver

disease ? Yes ,but its ” acute liver insult “• Viral• Metabolic• Alcohol• Autoimmune• Vascular• Toxins• Drugs• Inherited disorders

معوني س

؟ يايشه

Chronic liver disease Cirrhosis

hepatic Encephalopathy

Dr . Yasir M Khayyat MBcHB,FRCPC,FACP,ABIM

Assistant professor of Medicine

Faculty of Medicine

Umm AlQura University

Acute Liver insultChronic Inflammation

Or Chronic Hepatitis

Healing with FibrosisOr

Liver Cirrhosis

Development of Portal hypertensionAnd

Development of stigmata of Chronic Liver disease

Resolution without Clinical

or

histological consequences

Compensated StateCompensated Cirrhosis

Decompensated StateOr

Decompensated Cirrhosis

End Stage liver disease

HCCdeath

Natural history of Cirrhosis

• 50 % over 10 years

Compensated Cirrhosis

Decompensated Cirrhosis

Which is……

Ascites

50 % die in 2 years

Variceal hemorrhage

Hepatic Encephalopathy

• Varices develop in 50-60 % of cirrhotics

• Annual rate of development 2-5 %

• 30% of them develop UGIB

• Risk of rebleeding (2nd bleeding ) 60-70% over 24 months

• Death in cirrhotics 1/5 – 1/3 ,due to variceal bleeding

Stigmata of Chronic Liver disease

• Clubbing • Leukonychia • Palmar erythema • Dupuytren's contracture • Asterixis• Spider angiomata• Purpura • Gynaecomastia or Feminizing Hair Re-distribution • Testicular atrophy • Hepatomegaly • Splenomegaly • Ascites• Distended abdominal veins in which flow is away from the

umbilicus (caput medusae)

Clinical features

Symptoms

Complications: Portal hypertension

• Hepatic encephalopathy

• GI bleeding

• Ascites

• Lower limbs edema

Incidental abnormality of LFT

Clinical features

Symptoms

Complications: Portal hypertension

• Hepatic encephalopathy

• GI bleeding

• Ascites

• Lower limbs edema

Incidental abnormality of LFT

• Gynecomastia due to hypersestogenemia state

• Also noted in spironolactone use

Flapping tremor due

to

False neurotransmitters

Causing imbalance at

the cerebellar function

• Caput medusa

• due to portal

• hypertension with collateral

• formation between

paraumbilical veins that arise from the umbilical portion of the left portal vein that connect to

the epigastric and and internal mammry veins through

the round ligament

Causes of Chronic Liver

diseases

Causes of chronic liver diseaseViralMetabolic VascularAutoimmune

AlcoholHemochromatosisPortal

Vein

thrombosis

Autoimmune hepatitis

InheritedWilson’s diseaseHepatic

Vein

thrombosis

Primary biliary cirrhosis

ToxinsCCl 4

Aflatoxin

α1antitrypsin

deficiency

Non Alcoholic

Fatty Liver

Disease

Primary sclerosing

cholangitis

Laboratory markers for HBV infection and its interpretation MarkerInterpretation

HBsAg Exposure to Hepatitis B virus. Present in

acute or chronic infection Anti-HBs antibody Immunity acquired via natural

infection or immunisation HBeAg Marker of infectivity. It correlates with

high level of viral replication Anti-HBe antibody It correlates with low level of viral

replication Anti-HBc IgM antibody Infection in previous 6 months

Anti-HBc IgG antibodyDistant HBV infection or chronic HBV

infection Hep B DNA >105 copies /mL Rapid viral replication

Diagnosis of HCV infection