CHRONIC LIVER DISEASE DEFINITION Defined as continuing liver

CHRONIC LIVER DISEASE

DEFINITION • Defined as continuing liver inflammatory lesion of liver with the potential to – Progress to more severe disease – Continue unchanged – Subside spontaneously or with treatment

ETIOLOGY • INFECTIOUS hepatits B, hepatitis C • METABOLIC Wilson disease, GSD type 3 &4, galactosemia etc • AUTOIMMUNE • CHRONIC DRUG INDUCED

CLINICAL PRESENTATION • ASYMPTOMATIC • INSIDIOUS ONSET • ACUTE • FULMINANT

WHEN TO SUSPECT CLD • Family H/O Liver disease • Relapse Of Acute Hepatitis • Persistence Of C/F Of Acute Hepatitis For >3 Months • Previous H/O HEP B, C • Unexplained hepatomegaly without jaundice

DIAGNOSIS • HISTORY • PHYSICAL EXAMINATION

Scoring System of CLD • CHILD PUGH CLASSIFICATION • PELD CLASSIFICATION

Chronic Liver Disease - Decompensation • Ascites • GI bleeding • Encephalopathy • Jaundice

LAB INVESTIGATIONS • DUE TO HEPATOCYTE INJURY • DUE TO HEPATIC SYNTHETIC DYSFUNCTION • SPECIFIC TESTS: VIRAL MARKERS, WILSONS DS, AUTOIMMUNE DS, METABOLIC DISORDERS • DRUG LEVELS

IMAGING • RADIOLOGICAL – USG ABDOMEN – HIDA SCAN • LIVER BIOPSY

TREATMENT • SUPPORTIVE • SPECIFIC: DRUG THERAPY • TREATMENT OF COMPLICATIONS

DRUG THERAPY • HEPATITIS B – IFN – LAMIVUDINE – ADEFOVIR, ENTECAVIR • HEPATITIS C –PEG-INF –RIBAVIRIN • AUTOIMMUNE –CORTICOSTEROIDS –AZATHIOPRINE –CYCLOSPORINE

COMPLICATIONS • • • PORTAL HYPERTENSION HEPATOPULMONARY SYNDROME HEPATORENAL SYNDROME ENCEPHALOPATHY SPONTANEOUS BACTERIAL PERITONITIS HEPATOCELLULAR CARCINOMA

WILSON DISEASE • Genetic defect blocking the natural excretion of absorbed copper from the liver. • Most common metabolic liver disease. • ATP 7 B gene---chromosome 13 • Toxic accumulation in liver brain cornea • Age of presentation 5 -50 years---hepatic &neurological

• Diagnosis-S. ceruloplasmin/24 hr urinary copper/KF ring/liver biopsy. • Treatment -Induction-trientene, penicillamine Maintenance-zinc

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HBs. Ag Anti HBs + Ig. M anti HBc Ig. G anti HBc + + HBe. Ag Anti HBe + + + + +/- + + +

Acute Hepatitis B Virus Infection with Recovery Typical Serologic Course Symptoms HBe. Ag anti-HBe Total anti-HBc Titre 0 4 anti-HBs Ig. M anti-HBc HBs. Ag 8 12 16 20 24 28 32 36 Weeks after Exposure 52 100

TYPICAL CLINICAL CHALLENGES • The jaundiced newborn • Giant cell hepatitis • Congenital infection • Metabolic liver disease • Choledochal cyst • Biliary atresia • The child with elevated liver enzymes • Viral hepatitis (A, B, C, D, E, G, etc. ) • Autoimmune hepatitis • Metabolic liver disease • Nonalcoholic fatty liver disease • The jaundiced child • Sclerosing cholangitis • Gallstones • Neoplasms • Biliary tract anomalies • The child with liver failure • Fulminant • Acute • Chronic

CLASSIFICATION • ETIOLOGY • GRADE OF NECROINFLAMMATION • STAGE OR EXTENT OF FIBROSIS