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Common Hepatic Disorders and Their Management

Dr. Beena Thomas

The Liver has a great capacity to renew itself. During Surgery, if a portion of the liver is cut away, it gets replaced within a few weeks. However in diseased conditions, the create of cell destruction may outstrip the rate of replacement. This may lead to liver disorders.This issue deals with Common Liver Disorders.


Liver is the largest chemical factory in our body and it was at one time considered the seat of life; hence its name-liver, the thing we live with.

The Liver has a great capacity to renew itself. During Surgery, if a portion of the liver is cut away, it gets replaced within a few weeks. However in diseased conditions, the rate of cell destruction may outstrip the rate of replacement. This may lead to liver disorders.

This issue deals with Common Liver Disorders. The topic has been described under following subheads:

I. Acute Hepatitis
II. Chronic Hepatitis
III. Cirrhosis of Liver

Acute Hepatitis
Is characterized by inflammation and destruction of hepatocytes. It may be caused by viral infection, bacterial infections, reaction to drugs and alcohol excess.

Acute Viral Hepatitis: Many viruses can invade and damage the liver but at least five viruses, A.B.C.D and E are liver specific or hepatotropic having a special affinity for liver cells.

a) Hepatitis A virus (HAV) causes what was once called infections hepatitis, since it is highly infections and spreads easily in epidemics by the faecal-oral route.

B) Hepatitis B virus (HBV) causes what was previously called serum hepatitis since it can be transmitted via blood (both from infusions and through contaminated needles), saliva, br**st milk, urine, semen and va***nal secretions.

C) Hepatitis C virus (HCV) is usually transmitted via transfusion of blood and its products.

D) Hepatitis D virus (HDV) has the same transmission as HBV.

E) Hepatitis E virus (DEV) reported for the first time in the outbreak which occurred in Delhi in 1956. The transmission is via faecal oral route.

The symptoms include malaise, fatigue, anorexia, loss of taste, distaste for smoking or alcohol, nausea, abdominal pan (primarily of right upper abdominal quadrant), fever, arthralgia, generalized muscular aches and rashes. The presence of dark urine, light colored stools or frank jaundice (serum bilirubin exceeds 2-4mg/100ml) may indicate the hepatic origin of the symptoms. The liver is usually enlarged, smooth and tender on palpation. The spleen may become palpable in a few cases.

Bacterial Hepatitis: Like viruses, bacteria can also invade liver cells and cause acute hepatitis. However they never cause chronic hepatitis. The bacteria causing hepatitis include Entamoeba histolytica (amoebic hepatitis), septicaemia, leptospirosis, syphilis, tuberculosis, parasitic infection (Malaria, Leishmaniasis, hydrated disease & Schistosomiasis).

Drugs or Toxic Hepatitis: Drugs metabolized in liver cells are usually oxidized and then conjugated with amino acids or sugars before They are excreted into bile. Propylthiouracil, tetracycline can produce fatal liver damage. Erythromycin esters are well established causes of hepatic damage. All sulphonamides can cause of hepatic damage. All Sulphonamides can cause liver damage, though the frequency with which they do this is low.

Alcoholic Hepatitis

Is a necro-inflammatory disorder of the liver which occurs in 10-20% of chronic alcoholics. The patient may be ill with anorexia, vomiting, jaundice, fever, confusion, delirium, spider naevi and large tender liver. Although most patients improve and their appetite returns on withdrawal of alcohol, many are only mildly affected and rapidly develop progressive fatal liver failure with ascites. Jaundice, abnormal blood clotting and encephalopathy. Ethanol contained in alcohol may be a leading cause of injury to liver. The daily amount of alcohol to cause alcoholic disease varies from person to person. However, 80-150g/day of alcohol consumption for 5 years has given rise of toxic changes in liver. Females run a greater risk, as 5-10 fold increase in liver disorder occur as compared to males drinking a similar quantity of ethanol. The British Medical Association (BMA) recommended 21 units of alcohol a week for man and 14 for a woman as ‘low risk’ limits. BMA further warned that these should not be regarded as ‘Safe drinking levels’ One Unit of alcohol represents 10ml of wine or 1/2 pint of beer or one measure of whisky. Wine is the safest drink as compared to beer or whisky.

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