Radiography second year Semester 4

Liver Diseases by:

Imtithal Elsayed Ibrahim Contact number: 0965004976

Objectives

By the end of this lesson you will be able to:

Identify normal structure and function of the liver.

Classify liver diseases.

Define each liver disease.

Contrast between acute & chronic hepatitis.

Discuss the pathogenesis of liver cirrhosis

Liver Functions

:Excretory Function Bile main excretory product Metabolic: Essential for intermediary metabolism of carbohydrates, fats, proteins Storage: Major storage site for carbohydrates and lipids Synthesis: Of all major plasma proteins, except immunoglobulin

EXRETION OF BILLUBIN

Classification of liver diseases Inflammatory: Hepatitis. cirrhosis. Other inflammatory & infectious diseases. Liver Abscesses. Granulomatous Disease. Vascular diseases. Hepatic Vein Outflow Obstruction Cancer: Primary Secondary.

Viral Hepatitis

Inflammation of the liver caused by Hepatropic viruses: A, B, C, D, E, G Occurs in the course of several systemic viral diseases: Epstein-Barr virus Herpes simplex type I and II Varicella-zoster virus Measles Cytomegalovirus.

Hepatitis A (HAV)

Fecal-oral route Symptoms Short lived, mild, fever with vomiting Loss of appetite Jaundice Prognosis: Good Recovery: 4-8 weeks Only causes acute hepatitis Vaccine available.

Hepatitis B (HBV)

Transmission: Exposure to infectious blood or body fluids containing blood Symptoms Weakness, nausea, and vomiting. Jaundice. Prognosis: variable. Most recover completely from acute phase transition into chronic hepatitis, even without acute phase. Increase risk of primary liver cancer. Vaccine available

Hepatitis C (HCV)

Transmission: Contact with the blood of an infected person, primarily through sharing contaminated needles to inject drugs

Most common viral cause of hepatitis.

Most common one transmitted by blood transfusion.

Similar presentation to HBV, just less severe

Prognosis

Tendency to develop into chronic hepatitis, and later cirrhosis and cancer

No vaccine

Clinical Features and Outcomes for Viral Hepatitis

• Asymptomatic acute infection.

• Acute hepatitis.

• Fulminant hepatitis: submassive to massive hepatic necrosis with acute liver failure

• Chronic hepatitis: with or without progression to

cirrhosis

• Chronic carrier state: asymptomatic without apparent disease

Fulminant Hepatitis

In a very small proportion of patients

with acute hepatitis A, B, D, or E, acute liver failure may result from massive hepatic necrosis

Chronic Hepatitis

defined by the presence of symptomatic, biochemical, or serologic evidence of continuing or relapsing hepatic disease for more than 6 months. histological features: inflammation and necrosis of hepatocytes. and regeneration. loss of normal architecture. Fibrosis. Inflammatory infiltrate.

Hepatic Failure The most severe clinical consequence of liver disease .

Due to progressive damage to the liver that lead to loss of 80%

to 90% of hepatic function.

Patterns of injury that cause liver failure:

Acute liver failure with massive hepatic necrosis: caused by drugs or viral hepatitis , progresses from onset of symptoms to hepatic encephalopathy within 2 to 3 weeks.

Chronic liver disease:

the most common cause, ends in cirrhosis.

Liver Cirrhosis

a diffuse process characterized by fibrosis and the conversion of normal liver architecture into structurally abnormal nodules.

loss of normal liver structure and function.

Characteristics of cirrhosis

Involvement of most or all of the liver.

bridging fibrous septa and regenerative nodules. .

according to the size of regenerative nodules liver cirrohis can be: .

Micronodular.

Macronodular .

MICRONODULAR CIRRHOSIS

Masson trichrome stain demonstrate fibrous bands around nodules.

Cirrhosis

Cirrhosis usually is an end-stage process that may have multiple causes.

The most frequent are chronic hepatitis

B and C and alcoholic and nonalcoholic hepatitis.

Less frequent causes are autoimmune , biliary diseases and metabolic conditions

Complications of liver cirrhosis

Decreased liver function:

Decrease protein synthesis lead to low albumin( low oncotic pressure) & clotting factors(bleeding).

Portal hypertension:

Results from increased resistance to portal flow at the level of the sinusoids & compression of central veins by perivenular fibrosis and expanded parenchymal nodules, lead to portosystemic shunting .

Hepatic encephalopathy .

Increase risk of liver cancer.

Hepatic encephalopathy

Brain dysfunction ranging from mild behavioral abnormalities to deep coma and death

may develop rapidly in acute liver failure or gradually with chronic liver failure from cirrhosis.

Pathogenesis :

Severe loss of hepatocellular function.

Shunting of blood from portal to systemic circulation

Portal vein

Clinical feature of liver cirrhosis

Jaundice .

Poor digestion of food

Malnutrition

Fatigue

Splenomegaly

Increased bleeding tendency.

Stigmata of chronic liver diseases: spider navie , loss of normal hair distribution, gynecomastia, palmar erythema.

Alcoholic Liver Disease

Alcohol inhibits some enzymes and stimulates others in liver

Can cause

Fatty liver

Alcoholic hepatitis

Cirrhosis

Liver cancer

Metastases to the Liver: Much more common than primary tumors Primary tumors from GI tract, lungs, breast liver enlargement Other symptoms Jaundice Ascites

Most patients die within months after these metastases have been identified

Primary liver tumors

Benign Tumors:

Hemangioma.

Hepatic Adenoma.

Malignant tumors:

Hepatocellular carcinoma

Hepatocellular carcinoma

Risk factors:

HCV.

HBV.

Aflatoxin.

Liver cirrhosis .

HCC

HCC

Radiologic screening of patients with cirrhosis at 6-month intervals, looking for dysplastic nodules or early, small hepatocellular carcinomas, is the current clinical practice.

CT Abdomen: HCC