liver disease avnish

8/14/2019 Liver Disease Avnish

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Liver Diseases

Dr. Avnish UpadhyayClinical Research Scientist

Department of Clinical ResearchPatanjali Yog Peeth, Divya Yog Mandir Trust, Haridwar

(An Recognized R & D Institution by DSIR)


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1. Introduction

a. anatomical Position and weight- weighingbetween 3-4 pounds (Approximately 1.5 Kg). YourLiver is the largest internal organ in the body. It islocated on the right side of your abdomen, just

beneath your lower ribs.b. Functions- Processing most of the nutrients

absorbed from the intestine.

c. Removing drugs, Alcohol and other harmfulsubstances from the blood stream.

d. Manufacturing bile, its storage in GB.

e. Produces cholesterol- Blood clotting factors andcertain other Proteins.


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Introduction contd.

f. It needs to be stressed that the liver may be

Palpable after deep inspiration in the right

hypochondriam in normal healthy adults, 10

to 12% are such cases. The incidence ofpalpability of the left lobe in the epigastrium is

still more but in small children this part is

sometimes difficult to feel, Again the

incidence of palpability is still higher, becausein infants, the relative size of liver is bigger for

the size of the abdomen.


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Healthy Liver

This is what a healthy

liver is supposed to

look like:


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Damaged Liver

This is what a

damaged liver looks

like:


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Damaged liver Continuation


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Because of the complexity of the liver andits exposure to so many potentially toxicsubstances, it would seem specially

valnerable to disease. But the liver has anamazing capacity for regeneration- it canheal itself by replacing or repairing injuredcells. In cirrhosis healing process seems

to go slightly wrong. In response tochronic injury, cells called stellate cellsincrease dramatically in size and number.This lead to formation of excess scar

tissue that interferes with the livers abilityto function. And although group of cellsmay continue to regenerate , the pattern ofregeneration is not normal.


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Causes

1. Some people have cirrhosis

without an obvious cause

(Cryptogenic cirrhosis)2. Major cause is drinking excessive

amount of Alcohol over many in

years.3. Having certain forms of viral

hepatitis.


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2. Examination of Liver

1. On inspection if one sees

a. swelling in the Rt. Hypochondrium which on

palpation seems to be in the liver the

common conditions are1. Amoebic Liver Abscess.

2. A malignancy

b. First palpate Right and then Lt Lobe of Liver.c. Edge whether thin or thick, firm or soft.

d. Surface- smooth or nodular.


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2. Examination of Liver Contd.

2. Look for Tenderness- it is very important Point toconsider. it is tender in 3 conditions.

a. Infective hepatitis.

b. Amoebic Hepatitis and Amoebic Abscess.

c. CCF

Exclude CCF by the presence of dyspnoea,enlarged heart, engorged neck veins, edemas offeet.

Now there remain 2 common causes1. Hepatic Amoebiasis or Amoebic Liver Abscess.

2. Infective Hepatitis


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3. Hepatic Amoebiasis

It includes Amoebic Hepatitis and Amoebic LiverAbscess

a. main symptom is pain in hypochondrium (Right) and /orepigastrium rarely in Rt Shoulder

b. it may be of dull ache or as severe as biliary colic

c. The duration of pain Could be from a few days to fewweeks.

d. The pain in increased on turning on the side, more on theRt Side.

e. The pain is increased on deep breathing specially incases who have developed chest complications; oftenthere is fever.

f. Nausea. Vomiting, lose of appetite, jaundice are absent.

g. alcoholic are more prone to get disease.

h. Past history of dysentery may or may not be presenthowever a recent attack of diarrheas or dysentery if

present would favors the diagnosis very much.


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4. Physical sign is Tenderness of the Liver

a. May be elicited by hammering over the liver area Orby pressure on sub costal area after a deepinspiration. Rarely tenderness may be only in theepigastrium in the area of left lobe. The liver may not

be enlarged or may be enlarged, slightly, moderatelyor markedly, Therefore more time should be given ineliciting tenderness than size of the liver.

b. A lump in the liver area is a rarity.

c. No investigations are required. The may be normalor raised.

d. The Rt dome of diaphragm may be raised orimmobile. Immobility is more important. It can beseen on screening of the chest (Fluoroscopy)

e. Best is Therapeutic test with emetine Injection.


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Treatment

1. Emetine 60 mg 1M for 8-10 days - Rest if Possible

2. Chloroguin or Metronidazole- 2 Tabs twice dailyfor 2 days. After then 1 Tab twice daily for 21days (May cause slight nausea)

Flagyl (Metronidazole):- 400 to 800 mg TD for 8days may cause nausea and loss of appetite butthis is the effective dose, Dose of 200 mg TD isonly for intestinal amoebiasis.

If pain, fever and tenderness of the liver persistseven after emetine Tapping must not be delayedfinally, if an obvious lump is seen in the liverarea, it would always need aspiration.


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INFECTIVE HEPATITIS

It is due to virus and therefore a single case can

infect many others, So it should be taken

seriously.

Incubation Period is about 3-4 weeks, history ofjaundice in any family member or any friend,

neighbour or locality during past one month is

an important point to be elicited in history

taking. One can get 2-3 attacks of viral hepatitis during

the life time

Disease is common in small children and young

adults, It is rare after the age of 45-50 yrs.


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Dot Call This disease "Jaundice" because

Many People may suffer and recover without

jaundice. These patients get loss of appetite,

slight nausea and do not generally feel well for a

week or two. The only way to diagnose will be, by

eliciting history of jaundice in the family or

neighborhood during previous 3-4 weeks. An the

same time, in that particular patient, it is

impossible whether he is going to develop

jaundice or whether he would recover withoutdeveloping jaundice. The disease without

jaundice is called anicteric jaundice.

Fever with complete loss of appetite.


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Surgical jaundice will have to be excluded,surgical jaundice means jaundice caused by thedisease which produce obstruction in the flowof bile and the treatment is mainly surgical such

as bile duct obstruction due to stones. Carcinoma head pancreas (leading to

obstructing common bile ducts) Presence ofone or more severe upper abdominal pain, whilecolored stool and excessive pruritis would

favour for surgical jaundice. Prolonged administration of hormones or

promazine group of drugs will favour thediagnosis of drug hepatitis.


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Three stages

Stage 1

Complete loss of appetite, Patient does notwant even to see food. Nausea, vomiting,

Fever, body ache, general malaise. In the 1stweek there is no evidence of jaundice.Towards the end of 1st week the patientmight notice very high coloured urine.

In viral hepatitis patient does not complain ofpain in the liver area, may complain vaguediscomfort on questioning. Patient may lose2-3 kg body weight.


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Stage 2

Patient's relatives see jaundice.

As Jaundice deepens, the temperature

starts coming down and appetite startsimproving, So that by the end of 2nd week

the patient is left with deep Jaundice but

good appetite and no fever.


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Stage 3

Recovering to normal. Resume his work

Appetite improves weight gains.

Jaundice clears up by the end of third

week.

90-95% patients behave the above

manner, 5 to 10 PC would die after

going to hepatic coma (speciallyPregnant women)


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Symptoms of Prehepatic coma

1. Presence of Drowsiness

2. Abnormal Behaviour

3. Irritability

4- Tremors

Better to hospitalize

nothing can be done at this stage.


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Signs of Infective hepatitis

Jaundice

Tender liver

may or may not be enlarged

Investigations

SGPT

SGOT

Serum Billirubin


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Treatment

1. Inj Gamma Globulin .06 cc/LB body weightshould be given to all family members asprophylaxis, though they are very costly butshould ideally be given to all familymembers.

2. Tonics for appetite, Inj glucose 25 pc Iv. Cal.gluconate iv, Inj B comp., vit c, vit k,Antibiotics, Prednisolone 1 BD or TD, Inj.liver ext., two drugs are harmful as they canprecipitate hepatic coma. only glucose iv ororally is useful along with rest.


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Drugs

Antihistaminic and IV glucose is sufficient.

In severe case prednisolone 40 to 60 mg/day

gradually tapered off very slowly


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danger signals

The following are the danger signals, the

presence of any of them indicates on coming

hepatic coma and death

1. Drowsiness2. Reversal of sleep rhythm

3. Irritability

4. TremorsDeep Jaundice is not a sign of danger.


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liver disease avnish

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