Liver Disease

Liver Disease

Fatty liver, alcoholic liver disease; cirrhosis, primary biliary cirrhosis, primary sclerosing cholangitis and alpha 1 antitrypsin deficiency are all disorders that appear to result from an injury to the liver. Many factors can injure the liver, but in some of these disorders, the nature of the injury is not known

Fatty Liver:
Fatty liver is an excessive accumulation of fat (lipid) inside the liver cell. It was formerly believed that malnutrition rather than ethanol was responsible for steatosis (fatty metamorphosis) of the liver in alcohol. More recently, it has come to be agreed that the role of deficient nutrition in such individuals has been overemphasised. However, it cannot be ignored that inadequate diets specially those deficient in choline, methionine, and dietary protein? Can produce fatty liver (Kwashiorkor) in children. Sometimes the cause of fatty liver is not known; especially in newborns. In general, the known causes are injuries to the liver in some way. Fatty liver usually produces no symptoms. Rarely, it causes jaundice, nausea. vomiting; pain, and abdominal tenderness

A physical examination that reveals an enlarged liver without any other symptoms suggests fatty liver. The diagnosis may be confirmed by performing a liver biopsy, in which a long hollow needle is used to obtain a small tissue sample for examination under a microscope

The mere presence of excessive fat in the liver is not a serious problem. Treatment aims at eliminating the cause or treating the underlying disorder. Repeated liver injury from toxic substances such as alcohol may eventually progress from fatty liver to cirrhosis.

Alcoholic Liver Disease:
Alcoholic liver disease is damage to the liver that results from excessive drinking of alcohol. Alcoholic liver disease is a common, preventable health problem, in general amount of alcohol consumed (how much and how often) determines the risk and the degree of liver damage. Women are more vulnerable to liver damage than men. However, the amount of alcohol that causes liver damage varies from person to person; Alcohol may cause three types of liver damage, fat accumulation (fatty liver), inflammation (Alcoholic hepatitis), and scarring (cirrhosis).

Alcohol also provides calories without essential nutrients, decreases the appetite, and causes poor absorption of nutrients because of its toxic effects on the intestine and pancreas. As a result, people who regularly drink alcohol without eating properly develop malnutrition.

Symptoms and Diagnosis:
In general, symptoms depend on how long and how much a person has been drinking. In men alcohol may produce effects similar to those produced by too much oestrogen and too little testosterone : shrunken testes and breast enlargement.

People with liver damage from fat accumulation (fatty liver) usually have no symptoms. In some cases the liver may be enlarged and occasionally tender.

Inflammation of the liver induced by alcohol (Alcoholic hepatitis) may produce a fever, jaundice, an increased white blood cell count; and a tender and painful and enlarged liver. The skin may develop spiderlike veins. A person who has liver damage with scarring (cirrhosis) may have few symptoms or the features of alcoholic hepatitis. Such a person also may have complications of alcoholic cirrhosis: portal hypertension with spleen enlargement; ascitis (fluid accumulation in the abdominal cavity); kidney failure from liver failure (hepatorenal syndrome), confusion (one of the main symptoms of liver enceplalopathy), or liver cancer (hepatoma). To confirm the diagnosis of alcoholic liver disease in some cases, a doctor performs a liver biopsy. In this procedure; a hollow needle is inserted through the skin and a tiny piece of liver tissue is removed for examination under a microscope.

Prognosis and Treatment:
If the person continues to drink alcohol, liver damage will progress and probably be fatal If the person stops drinking, some of the liver damage (except that from scarring) may repair itself, and chances are good that the person will live longer. The only treatment for alcoholic liver disease is to stop drinking alcohol. Doing so can be extremely difficult, and most people need to participate in a formal programme to stop drinking run by NGOs combating drug problems:

Known Causes of Fatty Liver:

  1. Obesity
  2. Diabetes
  3. Chemicals and drugs (such as alcohol; corticosteroids, tetracyclines, valproic acid, methotrexate, carbon tetrachloride, and yellow phosphonis)
  4. Malnutrition and a diet that is deficient in protein.
  5. Pregnancy
  6. Vitamin A toxicity
  7. Bypass surgery of the small intestine
  8. Cystic fibrosis
  9. Reye's syndrome
  10. Hereditary defects in glycogen, galactoes tyrosine or haemocystine metabolism
  11. Medium chain aryldehydrogenase deficiency.
  12. Cholesterol esterase deficiency.
  13. Phytanic acid storage disease.
  14. Abetalipoproteinemia.

Cirrhosis of Liver:
Cirrhosis is the destruction of normal liver tissue that leaves non-functioning liver tissue

The concept of cirrhosis that evolved during the past few decades includes only these cases in which hepato cellular injury leads to both fibrosis and nodular regeneration througout the liver. These features delineate cirrhosis as a serious and irreversible disease which is characterised not only by variable degrees of hepatic cell dysfunction, but also by portosystemic shunting and portal hypertension.

Most of the common causes of liver injury result in cirrhosis. Alcohol abuse is the most common cause of liver cirrhosis in developed countries. Among people aged 45 to 65, cirrhosis is the third common cause of death after heart disease and cancer. In many parts of Asia and Africa, chronic hepatitis is a major cause of cirrhosis

Symptoms:
Mild cirrhosis may not produce any symptom and patient may feel no problem for years. Others may feel weak and may lose appetite, feel sick and lose weight. Jaundice, itching and small yellow skin nodule, especially around the eyelids may show up.

Malnutrition may occur due to poor appetite and impaired fat absorption and fat soluble vitamines absorption which is caused by reduced production of bile salts.

Occasionally, the person may cough up or vomit blood because of bleeding from varicose veins at the lower end of the esophagus (oesophageal varices), high blood pressure in the intestinal veins leading to liver causes these blood vessels to engorge and this phenomenon is called portal hypertension.

This along with poor liver function, may also lead to fluid accumulation in the abdomen (ascitis). Kidney failure and liver encephalopathy may develop. In long standing disease, muscle wasting, redness of the palms (palmer erythema), a curling up of fingers (Dupuytren's contracture of the palms), small spiderlike veins in the skin, breast enlargement in men (gynaecomastia), salivary gland enlargement in the cheeks, hair loss, shrinking of the testes (testicular atrophy) and abnormal nerve function (peripheral neuropathy) may occur.

Diagnosis:
Ultrasound scan may show enlargement of the liver. A definitive diagnosis is made by microscopic examination of a sample of liver tissue.

Prognosis and Treatment:
Cirrhosis is usually progressive. In early alcoholic cirrhosis scarring of the liver may stop with the stoppage of alcohol consumption but scar tissue remains indefinitely. Prognosis is usually poor and becomes poorer if blood vomitting, ascitis or abnormal brain function (encephalopathy) have occurred liver cancer is common in people with cirrhosis caused by chronic Hepatitis B or Hepatitis C infection. There is no cure for cirrhosis. symptomatic relief may be provided. Liver transplant may help in advanced liver cirrhosis cases.

Submitted By
Dr. Maswoodur Rahman Prince

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