Hepatobiliary & Gall Bladder Disorders

Jaundice

HBA > yellowish pigmentation of the skin, sclerae & mucous membranes

Conjugated type; due to secretory bile obstruction > lowered conjugated bilirubin excretion

Unconjugated type; increased RBC lysis OR abnormal hepatocyte metabolism > elevated bilirubin

Haemochromatosis

Congenital (primary) or acquired (secondary) disorder > increased iron tissue deposition > chronic liver damage & cirrhosis

Hyperbilirubinaemia

Hepatitis Viral Infection

Virus

RNA/DNA

Mode of Transmission

Clinical Features

Diagnostic testing

Progesses to chronic liver disease?

HAV

RNA

Faeco-oral route

Malaise, jaundice & recovery

N/A

No

HBV

DNA

Parenteral, sexual contact, mother-child

Acute self-limiting, filminant acute , chronic or asymptomatic

Detection of surface protein complement, core components, markers of viral replication, viral replication in the blood

Maybe

HCV

RNA

Parenteral, sexual contact, mother-child

Acute hepatitis, recovery, fulminant hepatitis, relapsing/remitting chronic disease, cirrhosis, hepatocarcinoma

PCR detection of HCV RNA & HCV antibodies

Maybe

HDV

RNA

Parenteral, sexual contact, mother-child

Requires HBV infection presence

Detection of anti D & HBc antibodies, PCR detection of blood HDV RNA

Maybe

HEV

RNA

Faeco-oral route

Malaise, jaundice, recovery, acute fulminant hepatitis (pregnant women)

N/A

No

Hepatitis

Metabolic Liver Diseases

Cirrhosis

Tumours & Abnormal Growths

Liver Disorders in Children

Cholethiasis & Cholecystitis

a1-antitrypsin Deficiency

Dysfunctional liver production of protein > reduced activity in blood & lungs OR excessive a1-antitrypsin in the liver > chronic liver damage & cirrhosis

Wilson's Disease (congenital)

Impaired copper metabolism & excretion > abnormal copper accumulation > chronic liver damage & cirrhosis

- Copper deposition in brain/cornea = Kayser-Fleischer rings

Haemangiomas

Black lesions w/ abnormal vascular channels (within collagenous stroma)

Clinical Features

Hepatocellular Failure; jaundice, xanthelasmasma, foetor hepaticus "liver breath", palmar erythema "liver palms", gynaecomastia, spider naevi, testicular atrophy, systemic oedema, haemorrhagic tendency, leukonychia, koilonychia (iron def.), finger clubbing (O2 def.)

Portal Hypertension; fibrotic liver > portal venous pathway compromised > splenomegaly

- May lead to oesophageal varices, haemorrhoids, umbilical veins or ascites (due to redirected pathways)

Hepatocarcinoma; Cirrhosis (pre-malignant due to dysplasia) > primary hepatocarcinoma (possibly due to mycotoxins & "Butter Yellow" carcinogens)

Cholecystitis

Acute cholelithiasis/cystic duct obstruction > acute inflammation

Chronic gall stones > thickening, fibrosis, mucosal scarring, atrophy & cystic space formation

Cholethiasis

Accumulation of cholesterol, calcium salts & bilirubin > gall stone formation

- Due to reduced bile acids in bile, increased oestrogen levels, malabsorption or elevated bile cholesterol levels

Reye's Syndrome

Viral infection/aspirin administration > liver damage (fatty change, acute liver failure) & brain damage (cerebral oedema, brain injury)

Cystic Fibrosis

Viscous bile secretions > bile duct obstruction & jaundice > secondary biliary cirrhosis

Biliary Atresia

Intrahepatic atresia (within the liver) OR extrahepatic atresia (incompatent main extrahepatic ducts) > due to intraauterine inflammatory disease processes

Angiosarcoma

Malignancy of blood vessels > jaundice & multifocal haemorrhagic nodules

Colangiocarcinoma

Malignancy of the intrahepatic bile duct > normally metastasis to lungs, bones & lymph nodes

Secondary Liver Neoplasms

Commonly metastasised from colon, stomach, breast or lung > leading to hepatomegaly, jaundice, liver failure, obstruction of portal vein.

May have metastasised via portal vein, hepatic artery or direct spread

Bile Duct Adenomas/Hamartomas

Small white nodules present in liver capsule & abnormal bile ducts

Focal Nodular Hyperplasia

Hepatocyte hyperplasia

Hepatic Adenomas

Eoestrogen or contraceptives > Hepatic adenomas (well circumscribed)