What is the liver disease?

Hepatic disease

What is the liver disease?

Overview of liver functioning
Liver has critical role in
1. Metabolism
2. Digestion
3. Detoxification
4. Elimination of substances from body

All blood from intestines is passed through liver for processing, transformation and storage of products derived from digestion of food. These include amino acids, carbohydrates, fatty acids, cholesterol, lipids, vitamins and minerals. Liver play a role to regulate blood glucose levels. Major functions of liver are:
1. Hepatic excretory function: Organic compounds both endogenous and exogenous are biotransformed and excreted in bile and urine such as bilirubin and bile acids. Biotransformation converts lipophilic substances to hydrophilic substances for elimination.
2. Hepatic synthetic function: Liver has extensive synthetic capacity and play a major role in regulation of proteins, carbohydrate and lipid metabolism.
• Protein synthesis: Most of the major plasma proteins are synthesized in liver such as albumin, coagulation proteins.
• Lipid and lipoprotein synthesis: The liver extracts and processes dietary lipids and is the principle site for cholesterol, triglycerides and lipoprotein synthesis.
• Urea synthesis: Urea is synthesized in liver from proteins and amino acids.
• Hormone synthesis: Liver also involved in hormone synthesis such as insulin like growth factor 1, angiotensinogen, hepcidin, thrombopoietin, erythropoietin and pro hormone 25-OH vitamin D.
3. Hepatic metabolic functions: Metabolism of drugs (activation and detoxification) and disposal of exogenous and endogenous substances such as galactose and ammonia. Liver is the major processor of dietary and endogenous carbohydrates. Liver is the major site for gluconeogenesis and glycogen storage. Xenobiotics are chemical substances that are foreign to the biological system are cleared and / or metabolized by liver.
4. Hepatic storage function: Liver serves as major site for carbohydrate storage. Liver also stores vitamin and minerals such as vitamin A, D, E, K and B12, iron and copper.
Any injury or disease of liver causes loss of these functions and leading to manifestations of liver disease.

What are the causes of liver disease?

Liver diseases are categorized as:
• Hepatitis:
. o Acute hepatitis:
. -Viral hepatitis: Hepatitis A, B, C, D, E
. -Bacterial and protozoal infections: liver abscess
. -Drug induced hepatitis
. -Autoimmune hepatitis
. o Chronic hepatitis
. o Alcoholic hepatitis/ Alcoholic liver disease
. o Nonalcoholic fatty liver disease and hepatitis
• Cholestasis
• Tumors
• Congenital liver disease:
. o Hemochromatosis
. o Wilson's disease
. o Alpha-1 antitrypsin deficiency
• Cirrhosis: End stage liver disease

What are the symptoms of liver disease?

Signs and symptoms of liver disease are:
• Jaundice: Yellowish discoloration of skin and eyes due to increased bilirubin.
• Fever
• Malaise
• Loss of appetite
• Pain abdomen
• Itchy skin
• Dark colored urine
• Pale/ clay colored stool
• Fatigue
• Nausea, vomiting
• GIT Bleeding
• Swelling of legs or generalized
• Abdominal swelling
• Dry and scaly skin

What are the complications if liver disease?

Long term complications of liver diseases include:
o Portal hypertension
o Bleeding esophageal varices
o Ascites
o Peritonitis
o Hepatic encephalopathy
o Hepatic failure
o Hepatorenal syndrome
o Alteed drug metabolism
o Nutritional and metabolic abnormalities
o Disorders of hemostasis
o Tumors: Hepatocellular carcinoma

What are the risk factors for liver disease?

Factors that may increase the risk of liver disease are:
• Heavy alcohol drinking
• Overweight/ Obesity
• Type 2 diabetes mellitus
• Tattoos or body piercings
• Injecting drugs using shared needles
• Blood transfusion
• Exposure to other people's blood and body fluids
• Unprotected sex
• Exposure to certain chemicals, drugs or toxins
• Family history of liver disease

What are the laboratory tests to diagnose liver disease?

Laboratory investigations to diagnose or confirm liver diseases are:
• Blood tests:
o CBC
o Liver function tests (LFT): Serum albumin, ALP, ALT, AST, total bilirubin, direct bilirubin, indirect bilirubin, serum total protein, serum globulin, A/G ratio, AST/ALT ratio
o PTI/ INR
o Blood sugar
o KFT
o HbsAg
o Anti HCV
o Anti HAV
o Anti HEV
o Serum amylase
o Serum lipase
• Imaging: Ultrasound, CT scan and MRI scan.
• Liver biopsy

What are the laboratory tests to diagnose liver disease?

Laboratory investigations to diagnose or confirm liver diseases are:
• Blood tests:
o CBC
o Liver function tests (LFT): Serum albumin, ALP, ALT, AST, total bilirubin, direct bilirubin, indirect bilirubin, serum total protein, serum globulin, A/G ratio, AST/ALT ratio
o PTI/ INR
o Blood sugar
o KFT
o HbsAg
o Anti HCV
o Anti HAV
o Anti HEV
o Serum amylase
o Serum lipase
• Imaging: Ultrasound, CT scan and MRI scan.
• Liver biopsy