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