Liver disease Lec 9 Bioc 416 Acute hepatitis

Liver disease Lec. 9 Bioc 416

Acute hepatitis It caused by viral infection or toxins such as (alcohol, paracetamol, carbon tetrachloride and various fungal toxins) Bilirubin and urobilinogin are detectable in urine by simple dip-stick technique. Plasma bilirubin raised and urobilinogin disappear from the urine at the height jaundice because no bilirubin reach the gut.

Detection of bilirubin in the urine is a pointer to hepatitis in pre-icteric stage.

Chronic hepatitis (Autoimmune hepatitis) It is a hepatic inflammation persisting for more than 6 months. Chronic infection with hepatitis B or C, alcohol. Occurs in either sex and at any age. In Chronic hepatitis ↑ of plasma aminotransferase activity.

Acute liver failure The most frequent causes are : toxins (paracetamol) and hepatitis. Metabolic disturbance is profound. It is accompanied by renal failure. Acute liver failure include hyponatraemia, hypocalcaemia, hydrogen ion disturbance and (other disturbance……)

Plasma urea conc. is often low Plasma creatinine is reliable guide for detecting liver failure but some times it interfere with bilirubin and produce invalid results in patient with jaundice

Cirrhosis Causes of cirrhosis: • Chronic excessive alcohol intake. • Autoimmune hepatitis. • primary biliary cirrhosis. • Hepatitis B, C. • Inherited metabolic diseases. No reliable biochemical test to diagnose subclinical disease No routine hepatic function tests are used.

Procollagen type III peptide (PIIINP) its conc. in the plasma reflects the rate of development ↑↑ of fibrosis, inflammation or necrosis. Plasma PIIINP conc. monitoring patients treated with drugs which causes hepatic fibrosis.

Liver necrosis

Biliary fibrosis

Alcohol and the liver Alcohol causes liver disease. Fat accumulation. ↑↑ plasma aminotransferases, marked ↑↑ in GGT activity and a normal bilirubin conc. Only 10 -20% of chronic alcoholics develop cirrhosis.

The investigation of jaundice In adults jaundice is usually mild due to unconjugated hyperbilirubinaemia Causes of jaundice are: *Gilbert’s syndrome. *Haemolysis. Bilirubin is absent from urine.

Biochemical tests : • ↑↑ plasma aminotransferase → It may hepatocellular damage. • very ↑↑ in ALP → It may Cholestasis

Gallstones and biliary tract disease They composed of cholesterol, bilirubin and calcium salts. Cholesterol maintained in bile by virtue of the surface-active properties of bile salt and lecithin. A change in these component proportion it lead to stone formation

Stones consisting of bilirubin diglucuronide develop in patient with chronic haemolytic anaemias. Gallstones clinically silent. They cause biliary colic, obstruction and cholecystitis, cholangitis, pancreatitis. Primary sclerosing cholangitis (PSC) is a inflammation→fibrosis biliary system → cirrhosis → liver failure.

There are two important tumour markers in monitoring PSC: - Plasma CA 19 -9 its conc. ↑ in PSC - Plasma CEA (carcinembryonic antigen) its conc. normal in PSC and ↑ ↑ in cholangiocarcinoma.