Liver and the Biliary Tract

Posted by e-Medical PPT Sunday, August 26, 2012
Hepatic Injury
Inflammation = hepatitis
Degeneration-Damage from toxic or immunologic insult
Accumulation of substances, e.g., steatosis
Cell death-Centrilobular, submassive, massive necrosis
Fibrosis-Usually irreversible
Cirrhosis

Cholestasis
Systemic retention of not only bilirubin but also other solutes eliminated in bile, particularly bile salts and cholesterol
Due to hepatocellular dysfunction or biliary obstruction
Accumulation of bile pigment within the hepatic parenchyma – Kupffer cells
Bile ductular proliferation
Bile lakes
Portal tract fibrosis

Hepatic Failure
80% to 90% of hepatic functional capacity must to destroyed
Massive hepatic necrosis
   Fulminant viral hepatitis
   Drugs and chemicals, e.g., acetaminophen, carbon tetrachloride, mushroom poisoning
Chronic liver disease
Hepatic dysfunction without overt necrosis
   Acute fatty liver of pregnancy
   Tetracycline toxicity
   Reye syndrome

Complications
Multiple organ failure
Coagulopathy
Hepatic encephalopathy
   Metabolic disorder of the CNS and NMS
   Elevated blood ammonia level and deranged neurotransmission
   Rigidity, hyperreflexia, seizures
   Asterixis
Hepatorenal syndrome
 Idiopathic renal failure

Cirrhosis
Bridging fibrous septa
Parenchymal nodules
Disruption of the architecture of the entire liver
Etiologies
  Alcoholic liver disease 60% to 70%
  Viral hepatitis 10%
  Biliary diseases 5% to 10%
  Hereditary hemochromatosis 5%
  Wilson disease rare
  Cryptogenic cirrhosis 10% to 15%
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