chronic liver disease cirrhosis hepatic encephalopathy

Chronic liver disease Cirrhosis

hepatic Encephalopathy

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

Assistant professor of MedicineFaculty 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

؟ ايشهي

Chronic liver disease Cirrhosis

hepatic Encephalopathy

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

Assistant professor of MedicineFaculty 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

SymptomsComplications: Portal hypertension• Hepatic encephalopathy• GI bleeding• Ascites• Lower limbs edemaIncidental abnormality of LFT

Clinical features

SymptomsComplications: Portal hypertension• Hepatic encephalopathy• GI bleeding• Ascites• Lower limbs edemaIncidental abnormality of LFT

• Gynecomastia due to hypersestogenemia state

• Also noted in spironolactone use

Flapping tremor due toFalse neurotransmittersCausing 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

AlcoholHemochromatosisPortalVein

thrombosis

Autoimmune hepatitis

InheritedWilson’s diseaseHepaticVein

thrombosis

Primary biliary cirrhosis

ToxinsCCl 4Aflatoxin

α1antitrypsindeficiency

Non AlcoholicFatty LiverDisease

Primary sclerosingcholangitis

Laboratory markers for HBV infection and its interpretation MarkerInterpretationHBsAg 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