5 liver disease
TRANSCRIPT
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LIVER DISEASES
Dr Rehan Ahmed KhanFCPS, FRCS, MHPE
Asstt. Prof. Surgery. S.U. 2
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LEARNING OBJECTIVES
To enlist important liver diseases
To enumerate clinical features of liver
diseases To describe surgical aspects of liver diseases
To describe portal hypertension
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MCQs
A 30 year old male presents with h/o high
grade fever, vomiting , tender right
hypochondrium .The diagnostic investigationof choice in this patient is:
A. Abdominal ultrasound
B.CT scan abdomen
C. MRI Abdomen
D. Xray Abdomen
E. FNAC
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MCQs
A 60 year old male presents with pain RHC,
jaundice and confusion.This patient will have
following tremors
A. INTENTIONAL TREMORS
B. FLAPPING TREMORS
C. FINE TREMORS
D. SENILE TREMORS
E. RESTING TREMORS
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MCQs
A. A 62 year old male presents with hematemesis. Hispulse is 120 /m and BP is 90/50 mm Hg. He has pallorand feels difficulty in breathing.Last year he was
diagnosed with hepartitis C.T
he most likely diagnosis is:A. Gastric varices
B. Esophageal varices
C. Bleeding duodenal ulcer
D. GastritisE. Erosive esophagitis
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THE LIVER
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THE LIVER
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THE LIVER
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LIVER DISEASES
Hepatitis A
B
C
Traumatic liver injury
Liver abscess
Cirrhosis Liver failure
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TRAUMATIC LIVER INJURY
Results from blunt abdominal trauma
Pain and tenderness in RHC
Shock Signs of free intraperitoneal fluid
Urgent resuscitation required
Operative repair to be done
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LIVER ABSCESS
Single or multiple
Amebic or pyogenic
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AMEBIC LIVER ABSCESS
Due to entameba histolytica
Usually solitary
Usually in the central part of right lobe Contains chocolate colored pus (anchovy
sauce pus)
Presents with fever, pain RHC, tenderness. H/o amebic dysentry
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AMEBIC LIVER ABSCESS (contd)
Investigate stools for ameba
USS abdomen
Ameba serology (indirect hemagglutinationtest)
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AMEBIC LIVER ABSCESS
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AMEBIC LIVER ABSCESS
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AMEBIC LIVER ABSCESS
Treatment
Conservative
Metronidazole (Flagyl) 800 mg tds for 10 days Tinidazole (Fasigyn)
Secnidazole (Secnidal)
Operative
Aspiration Operation
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CIRRHOSIS
Results from liver cell necrosis, regeneration
and fibrosis
End stage of many liver diseases Marks a degenerative change in liver
parenchyma
Macro- or micro nodular Leads to portal hypertension
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PORTAL CIRCULATION
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ESOPHAGEAL VARICES
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ESOPHAEGAL VARICES
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CAPUT MEDUSAE
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ASCITES
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ESOPHAGEAL VARICES
Upper GI bleed
Massive hemorrhage
Managed by NG intubation, cold saline lavageand IV vasopressin
Prompt endoscopy required
Injection sclerotherapy
Sengstaken tube insertion
?Surgery
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SENGSTAKEN TUBE
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THE TUBE IN PLACE
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LIVER FAILURE
Inability of liver to perform its normal
metabolic and synthetic functions.
May be acute or chronic Main clinical features are neurological in
nature
Confusion, stupor, coma--- hepaticencephalopathy
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CLINICAL FEATURES
Impaired sensorium
Flapping tremor, liver tremor or asterixis
Inability to perform simple tasks eg joiningdots
Maybe precipitated by metabolicderangements, diuretics (hypokalemia),
protien intake, drugs (psychotropics etc) andothers
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MANAGEMENT
Reduce protein intake
Correct hypokalemia
Oral lactulose Antibiotics
Supportive therapy
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MCQs
A 30 year old male presents with h/o high
grade fever, vomiting , tender right
hypochondrium .T
he diagnostic investigationof choice in this patient is:
A. Abdominal ultrasound
B.CT scan abdomen
C. MRI Abdomen
D. Xray Abdomen
E. FNAC
-
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MCQs
A 60 year old male presents with pain RHC,
jaundice and confusion.This patient will have
following tremors
A. INTENTIONAL TREMORS
B. FLAPPING TREMORS
C. FINE TREMORS
D. SENILE TREMORS
E. RESTING TREMORS