3. LIVER
Liver is one of the largest organ
in our body.,weighs upto 1500
grams in adults.
With the exception of the
brain, the liver is the most
complex organ in the body
And it has morethan 500
different vital functions in our
body.
Some of the more well-known
functions include the following:
Production of bile, which helps
carry away waste and break down
fats in the small intestine during
digestion
4. Production of certain proteins for blood plasma
Production of cholesterol and special proteins to help carry fats
through the body
Conversion of excess glucose into glycogen for storage (glycogen
can later be converted back to glucose for energy)
Regulation of blood levels of amino acids, which form the building
blocks of proteins
• Processing of haemoglobin for use of its iron content (the liver
stores iron)
• Conversion of poisonous ammonia to urea (urea is an end product of
protein metabolism and is excreted in the urine)
• Regulating blood clotting
• Resisting infections by producing immune factors and removing
bacteria from the bloodstream
5. • And yet, when your liver is damaged, you generally won’t
know about it – until things get serious.
• Liver disease is defined as acute or chronic liver on the basis
of whether the history of disease is lessthan/greater than
6months, respectively.
• The hepatocyte is the functioning unit of the liver.
• Liver is the only organ which is readily regenerate.
• Viral infections and paracetamol overdose are the leading
causes of acute liver disease, but a significant number of
patients have no defined aetiology.
• Alcohol abuse and chronic viral hepatitis(B and C) are the
major causes of chronic liver disease.
6. ALCOHOLIC LIVER CIRRHOSIS
Alcoholic liver disease is a term that encompasses the hepatic
manifestations of alcohol overconsumption, including fatty
liver, alcoholic hepatitis, and chronic hepatitis with hepatic
fibrosis or cirrhosis.
It is the major cause of liver disease in Western countries.
Term was 1st coined by Laennec in 1826
• Primary histologic features:
1. Marked fibrosis
2. Destruction of vascular & biliary elements
3. Regeneration
4. Nodule formation
7.
8. About Alcohol :
• Alcohol beverage is a drink that contains ethanol
• In the bloodstream, from the stomach, alcohol is absorbed between
5-10 minutes
• Fact : females absorb alcohol faster than males because their bodies
contain less water
Problem With Alcohol Beverages:
• Alcohol beverages are being consumed everyday, but consuming too
much can bring problems
• An example would be alcoholic liver disease(cirrhosis),heart
disease, cancer and strokes
• Cause addiction
9. Stages Of ALD :
There are three main stages of alcoholic liver disease, although there is
often an overlap between each stage. The three stages are explained
below.
Alcoholic fatty liver disease
• Alcoholic fatty liver disease is the first stage of alcoholic liver disease.
• Drinking a large amount of alcohol, even for only a few days, can lead
to a build-up of fatty acids in the liver.
• Fatty liver disease rarely causes any symptoms but it is an important
warning sign that you are drinking at a level that is harmful to your
health.
• Fatty liver disease is reversible. If you stop drinking alcohol for two
weeks, your liver should return to normal.
Alcoholic hepatitis
• Alcoholic hepatitis (not related to infectious hepatitis) is the second,
more serious stage of alcoholic liver disease.
10. • Prolonged alcohol misuse over many years can cause the tissues of the
liver to become inflamed. This is known as alcoholic hepatitis. Less
commonly, alcoholic hepatitis can occur if you drink a large amount of
alcohol in a short period of time (binge drinking).
• Alcoholic hepatitis is usually reversible, although you may need to stop
drinking alcohol for several months or years.
Cirrhosis
• Cirrhosis is the final stage of alcoholic liver disease. Cirrhosis happens
when prolonged inflammation causes scarring of the liver and loss of
function. Loss of liver function can be life threatening.
• The damage caused by cirrhosis is not reversible. In mild to moderate
cases, stopping drinking alcohol immediately should prevent further
damage and lead to the gradual recovery of liver function. In more
severe cases, a liver transplant may be required.
11. Epidemiology :
• In india, liver cirrhosis is one of the leading cause of death .
• 12th leading cause of death in the united states
• On average about 27,000 deaths per year
• 40% cases asymptomatic
• Additional 10,000 deaths due to liver cancer secondary to cirrhosis
• Overall, alcoholic liver disease accounts for well over a third (37%)
of liver disease deaths. And figures show victims of liver disease are
getting younger – more than 1 in 10 of deaths of people in their 40s
are from liver disease, most of them from alcoholic liver disease
12. Aetiology of liver cirrhosis
• Hepatitis C, fatty liver, and alcohol abuse are the most common causes
of cirrhosis of the liver., but anything that damages the liver can cause
cirrhosis, including:
• Fatty liver associated with obesity and diabetes
• Chronic viral infections of the liver (hepatitis types B, C, and D;
Hepatitis D is extremely rare)
• Blockage of the bile duct, which carries bile formed in the liver to
the intestines, where it helps in the digestion of fats; in babies, this can
be caused by biliary atresia in which bile ducts are absent or damaged,
causing bile to back up in the liver. In adults, bile ducts may become
inflamed, blocked, or scarred, due to another liver disease called
primary biliary cirrhosis.
• Repeated bouts of heart failure with fluid backing up into the liver
13. • Certain inherited diseases such as:
– Cystic fibrosis
– Glycogen storage diseases, in which the body is unable to
process glycogen, a form of sugar that is converted to glucose
and serves as a source of energy for the body
– Alpha 1 antitrypsin deficiency, an absence of a specific enzyme
in the liver
– Diseases caused by abnormal liver function, such as
hemochromatosis, a condition in which excessive iron is
absorbed and deposited into the liver and other organs,
and Wilson's disease, caused by the abnormal storage of copper
in the liver
• Although less likely, other causes of cirrhosis include reactions
to prescription drugs, prolonged exposure to environmental toxins,
or parasitic infections.
14. Risk Factors :
• The risk factors presently known are:
• Quantity of alcohol taken: consumption of 75–100 ml/day for 20 years or more in
men, or 25 ml/day for women significantly increases the risk of hepatitis and fibrosis
by 7 to 47%
• Pattern of drinking: drinking outside of meal times increases up to 2.7 times the
risk of alcoholic liver disease.
• Gender: females are twice as susceptible to alcohol-related liver disease, and may
develop alcoholic liver disease with shorter durations and doses of chronic
consumption. The lesser amount of alcohol dehydrogenase secreted in the gut, higher
proportion of body fat in women, and changes in fat absorption due to the menstrual
cycle
• Genetic factors: genetic factors predispose both to alcoholism and to alcoholic liver
disease. Monozygotic twins are more likely to be alcoholics and to develop liver
cirrhosis than dizygotic twins. Due to polymorphisms in the enzymes involved in the
metabolism of alcohol.
• Iron overload (Hemochromatosis)
• Diet: malnutrition, particularly vitamin A and E deficiencies, can worsen alcohol-
induced liver damage by preventing regeneration of hepatocytes. This is particularly
a concern as alcoholics are usually malnourished because of a poor diet, anorexia,
and encephalopathy.
16. Symptoms
Symptoms vary based on how bad the disease is. You may not have
symptoms in the early stages. Symptoms tend to be worse after a
period of heavy drinking.
Digestive symptoms include:
• Pain and swelling in the abdomen
• Decreased appetite and weight loss
• Nausea and vomiting
• Fatigue
• Dry mouth and increased thirst
17. Skin problems such as:
• Yellow color in the skin, mucus membranes, or eyes (jaundice)
• Small, red spider-like veins on the skin
• Very dark or pale skin
• Redness on the feet or hands
• Itching
Brain and nervous system symptoms include:
• Problems with thinking, memory, and mood
• Fainting and lightheadedness
• Numbness in legs and feet
18. Diagnostic tests
• Complete blood count (CBC)
• Liver biopsy
• Liver function tests
• Abdominal CT scan
• Blood tests for other causes of liver disease
• Ultrasound of the abdomen
And patient social history plays a vital role to determine
the disease.
19. Treatment
• The first treatment of alcohol-induced liver disease is cessation of
alcohol consumption. This is the only way to reverse liver damage
or prevent liver injury from worsening. Without treatment, most
patients with alcohol-induced liver damage will develop liver
cirrhosis
• Counseling may be necessary to break the alcohol addiction.
• Vitamins, especially B-complex and folic acid, can help reverse
malnutrition.
• Diet
• Liver transplantation
20. Case Study
• A 70 years old male patient was admitted in the hospital on 10/07/12
Chief Complaints :
C/o: abdominal distention since 4days
weakness since 15days
decreased appetite since 15days
weight loss since 15days
On Examination :
Patient is conscious and oriented
No cyanosis/icterus/clubbing
B.P-120/80 mm Hg RR-20 b/m
PR- 80b/m CVS-S1S2 +ve
21. Patient Medical History :
Not a k/c/o : HTNBADM
Past Medication History :
Not available
Social History :
Alcoholic,
Smoker,
Belongs to low economic status,
Married ,
Non-Allergic
23. • RFT
BUN-12mg/dL
Sr.Cr-0.7mg/dL
• Special investigations
Hbs Ag : -ve (impression)
US Abdomen : coarse texture
Gall Bladder : wall thickening
Spleen : enlarged mass
Diagnosis :
Alcoholic liver cirrhosis
24. Drug Chart
S.No Drug Name ROA Frequency Duration
10 11 12 13
1 Inj.Monocef (1g)
(cephalosporin–antibiotic )
IV BD Y Y - -
2 T.Udiliv(600mg)
(ursodeoxycholic acid)
po TDS - Y Y -
3 Inj.pantoprazole(40mg)
(proton pump inhibhitors)
IV BD Y Y y Y
4 Tab.Hepameez(10mg)
(L-ornithine+ L-aspartate)
PO OD Y Y Y Y
5 Inj.Metronidazole(160mg)
(anti-eleminthic)
IV OD _ Y _ _
6 Syp.duphalac (2tsp)
Bisacodyl - laxative
PO SOS Y Y Y Y
7 Inj.Amikacin(250mg) IV BD _ _ Y Y
25. SOAP NOTES
• SUBJECTIVE :
A 7OYrs old male patient was admitted in the hospital
on 10/7/12, with c/o: abdominal distension since 4days, weakness
since 15days, decreased appetite since 15days, weight loss since
15days,past medical & medication history nil, Social history -
Alcoholic, Smoker, Belongs to low economic status, Married , Non-
Allergic.
• OBJECTIVE :
patient was to be found, abnormalities of LFT, CBC&
social history &US Abdomen : coarse texture, Gall Bladder :
wall thickening, Spleen : enlarged mass.
26. • Assessment :
Based upon the above abnormalities,patient was
assessed to be suffering from alcoholic liver cirrhosis.
• Plan :
Refer to Drug Chart
27. Drug Chart
S.No Drug Name ROA Frequency Duration
10 11 12 13
1 Inj.Monocef (1g)
(cephalosporin–antibiotic )
IV BD Y Y - -
2 T.Udiliv(600mg)
(ursodeoxycholic acid)
po TDS - Y Y -
3 Inj.pantoprazole(40mg)
(proton pump inhibhitors)
IV BD Y Y y Y
4 Tab.Hepameez(10mg)
(L-ornbthine+ L-aspartate)
PO OD Y Y Y Y
5 Inj.Metronidazole(160mg)
(anti-eleminthic)
IV OD _ Y _ _
6 Syp.duphalac (2tsp)
Bisacodyl - laxative
PO SOS Y Y Y Y
7 Inj.Amikacin(250mg) IV BD _ _ Y Y
