Chronic liver disease Definition Pathologic o Liver biopsy

Chronic liver disease

Definition • Pathologic o Liver biopsy showing features of chronic inflammation or cirrhosis (Metavir, Knodell’s Scoring…) • Etiology • Clinical o Features of chronic liver stigmata, complications including portal hypertension

Etiology • Infection • Alcohol • Autoimmune • Cholestatic • Infiltrative • Metabolic • Vascular • Drugs • Cryptogenic

Viral Hepatitis Over View Virus Transmission Chronicity A Feco-oral No B Percutanous per mucosal Yes C Percutanous per mucosal Yes D Percutanous per mucosal Yes E Feco-oral No

Diagnosis • Medical history (parenteral risk factors) • Investigations o Biochemical § Serology( HBs. Ag, HBe. Ag, HCV Ab, HDV Ab, PCR) § LFT, CBC, PT o Radiologic imaging (Ultrasound, CT/MRI abdomen) o Pathology (Liver biopsy with features of chronic hepatitis or cirrhosis)

Alcoholic liver disease: • Steatosis • Acute alcoholic steatohepatitis • cirrhosis Depends on: o Consumed alcohol o Duration o Genetic predisposition

Autoimmune Hepatitis • Diagnosis o Autoantibody (ANA, SMA, LKM 1 Ab. . ) o Ig. G (Increased) o Liver biopsy (interface hepatitis)

Cholestatic liver disease • Primary biliary cirrhosis o AMA positive, increased Ig M & ALP • Sclerosing cholangitis o Increased ALP, association with IBD o ERCP showing beading of biliary ducts

Hepatic vascular disorder • Budd-Chiari syndrome (triad of tender hepatomegaly, ascites & spleenomegaly) • Portal vein thrombosis • Veno-occlusive disease

Drug induced liver disease • Cholestatic Antidepressant, ant seizure, anti fungal agents • Granulomas Allopurinol, pheytoin • Fibrosis Methotrexate, organic solvents • Phospholipidosis Amiodarone, TPN, septrin • Steatosis Tetracycline, glucocorticoids • Vascular Estrogens, azathioprine • Adenomas Estrogens

Metabolic liver disease • NASH o Risk factors : insulin resistance primary: (obesity, type II diabetes, dyslipidemia) secondary: (drugs, short bowel syndrome, TPN, metabolic) o Stages: • • I: Steatosis (macro vesicular) II: Steatosis + inflammation (centrilobular) III: Steatosis + inflammation + ballooning (degeneration & necrosis) IV: Steatosis + inflammation + ballooning + fibrosis +/- Mallory bodies

Metabolic liver disease • Alpha 1 -Antitrypsin Deficiency o Liver and lung involvement o Diagnosis using quantitative serum alpha 1 -antitrypsin & liver biopsy (PAS+, diastase resistant globules in periportal hepatocytes) • Hereditary Hemochromatosis o Increased iron absorption & deposition in liver, pancreas, skin, joints & o heart Increased transferrin saturation & Ferritin. HFE mutation analysis & liver biopsy ( increased hepatic iron index >1. 5 with >+2 Perls’ Prussian blue stain) • Wilson’s Disease o Autosomal recessive with copper accumulation in liver, brain, cornea, RBCs, o kidneys & joints due to defective copper transport and excretion. Serum ceruloplasmin is decreased with increased urinary & hepatic copper