Disease Of The Hepatobiliary System Long Essays

Disease Of The Hepatobiliary System Long Essays

Question 1. Describe etiopathogenesis, clinical features, diagnosis, and management of hepatic carcinoma.

Answer:

Hepatic Carcinoma:

• It is the most common type of liver cancer

Etiology:

• Hepatitis B and C infection.
• Alcoholism.
• Cirrhosis of the liver.
• Hemochromatosis.
• Wilsons disease.
• Oestrogen and androgen.
• Anabolic steroids.

Hepatic Carcinoma Clinical Features:

• Yellow skin.
• Bloating from fluid in the abdomen.
• Easy bruising.
• Loss of appetite n Weight loss
• Abdominal pain
• Nausea, vomiting
• Fatigue.
• Poly ischemia, hypoglycemia, hypercalcemia.

Hepatic Carcinoma Diagnosis:

• Serum alkaline phosphatase – high.
• Ultrasonography – shows carcinoma, lesion shows poorly defined margins.
• CT scan – detects small tumours.
• Angiography — shows tumor blushes.
• Liver aspiration – confirms tumour.

Hepatic Carcinoma Management:

• Liver transplantation.
• Surgical resection.
• Transcatheter arterial chemoembolization (TACE)
• Palliative therapy – use of cisplatin, and fluorouracil.
• Radiofrequency ablation.

Question 2. What are the causes of liver abscesses? Describe clinical features and complications of liver abscess.

Answer:

Liver Abscess:

• Liver abscess is a pus-filled mass inside the liver.

Etiology:

• Portal vein bacteremia from appendicitis, diverticulitis, and a perforated bowel.
• Systemic bacteremia via the hepatic artery.
• Ascending cholangitis.
• Penetrating trauma.
• Direct extension from focus of infection.

Liver Abscess Clinical Features:

• Subacute in onset.
• Jaundice
• Abdominal pain.
• Nausea, vomiting.
• Dark urine, clay-colored stools.
• Fever with chills.
• Loss of appetite.
• Weight loss.
• Weakness.

Liver Abscess Complications:

• Pleural effusion.
• Perforation of abscess with peritonitis
• Subphrenic abscess.
• Empyema,
• Hepatic coma.

Read And Learn More: General Medicine Question and Answers

Question 3. Classify jaundice. Describe etiology, clinical features, diagnosis, complications, and its management.

Answer:

Jaundice: Jaundice refers to yellow discoloration of skin, mucous membrane, sclera, and conjunctiva due to raised serum bilirubin.

Jaundice Classification:

1. Based on coloration of sclera.
   • Medical jaundice – yellow coloration.
   • Surgical jaundice – greenish-yellow coloration.
2. Based on etiology of jaundice.
   • Hemolytic.
   • Hepatic
   • Obstructive.
3. Based on chemical nature of bilirubin.
   • Unconjugated hyperbilirubinemia.
   • Conjugated hyperbilirubinemia.

Jaundice Causes:

1. Jaundice with predominantly unconjugated hyperbilirubinemia.
   • Hemolysis.
     • Intracorpuscular or extracorpuscular defects.
     • Drug-induced.
     • Infections.
   • Decreased uptake of bilirubin.
     • Drugs
     • Sepsis
     • Congenital
   • Decreased conjugation of bilirubin.
     • Neonatal jaundice.
     • Gilbert’s syndrome.
2. Jaundice with predominantly conjugated hyperbilirubinemia.
   • Intrahepatic cholestasis.
     • Congenital
     • Drugs and alcohol.
     • Hepatitis
     • Primary biliary cirrhosis.
     • Hodgkin’s lymphoma.
     • Postoperative.
   • Extrahepatic biliary obstruction.
     • Bile duct stone
     • Biliary stricture c Trauma
     • Tumour
     • Pancreatitis.

Jaundice Clinical Features:

Jaundice Diagnosis:

Jaundice Complications:

• Sepsis
• Biliary cirrhosis
• Pancreatitis
• Coagulopathy
• Renal and liver disease

Jaundice Management:

• Treat the causative agent.
• Discontinue the causative drug/toxin.
• Maintain adequate hydration and rest.
• Avoid alcohol.
• Use of analgesics to relieve pain, antibiotics for infections.
• Blood transfusion.

Question 4. Describe etiology, clinical features, complications diagnosis, and management of serum hepatitis B. Add a note on its prevention. (or) Enumerate the viruses causing acute hepatitis. Describe the clinical features and complications of viral hepatitis B. Add a note on the dental significance.

Answer:

Hepatitis: It is an acute parenchymal disease of liver.

Viruses Causing Acute Hepatitis:

1. Specific viruses.
   • Hepatitis A virus
   • Hepatitis B virus
   • Hepatitis C virus
   • Hepatitis D virus
   • Hepatitis E virus
2. Other viruses.
   • Cytomegalovirus
   • Epstein barr virus.
   • Herpes simplex virus.

Hepatitis B:

Etiology: It is caused by hepatitis B virus.

Hepatitis B Clinical Features:

1. Prodromal symptoms – Anicteric phase.
   • Occurs before the development of jaundice.
   • Fever with chills, malaise
   • Headache.
   • Aches and pain.
   • Nausea, vomiting, distaste for food.
   • Disturbed smell.
   • Dark-colored urine, clay-colored stools.
   • It lasts for few days to 2 weeks.
2. Icteric phase.
   • Jaundice occurs.
   • Enlarged and tender liver
   • Dark-colored urine, clay-colored stools
   • Pruritus.
   • Weight loss
3. Recovery phase.
   • It takes 2-8 weeks.
   • Jaundice starts regressing.
   • Full recovery occurs within 1-2 months.

Hepatitis B Complications:

• Cirrhosis of liver.
• Liver cancer
• Liver failure.
• Chronic renal diseases.

Hepatitis B Diagnosis:

• Serum transaminases – Rises
• High serum alkaline phosphatase level
• Serum bilirubin – 5 – 20 mg %.
• Prothrombin time – normal.
• Urine urobilinogen – Increased
• Ultrasound of liver – shows enlarged liver.

Hepatitis B Treatment:

• Bed rest.
• High-calorie diet.
• Intravenous fluid administration,
• Avoid hepatotoxic drugs
• Used of H₂ blockers and antacids.
• Liver transplantation.

Hepatitis B Prevention:

• Recombinant hepatitis B vaccine containing. HBs Ag is used for active immunization.

Hepatitis B Dental Significance:

• A significantly higher incidence of HBV occurs among dental staff.
• Vectors of infection are blood, saliva, and nasopharyngeal secretion.
• Intraorally, the greatest concentration of hepatitis B infection is gingival sulcus,
• Also, periodontal disease, severity of bleeding, and bad oral hygiene are associated with the risk of HBV.
• All dental healthcare workers should receive vaccination against hepatitis B.

Question 5. Discuss the etiology, clinical features, complications, and treatment of cirrhosis of the liver.

Answer:

Cirrhosis of Liver:

1. It is end result of hepatocellular injury characterized by triad of pathological changes i.e.,
   • Degeneration of hepatocytes.
   • Hyperplasia of remaining hepatocytes.
   • Fibrosis.

Cirrhosis of Liver Causes:

1. Common causes.
   • Alcohol.
   • Hepatitis B, C, non-A, non-B, non-C, viruses.
2. Other causes.
   • Autoimmune hepatitis.
   • Drug induced.
   • Biliary cirrhosis.
   • Haemochromatosis
   • Wilson’s disease
   • Cardiac cirrhosis.
   • Glycogen storage disease
   • Idiopathic.

Cirrhosis of Liver Clinical Features:

1. General
   • Fever, jaundice, weakness, fatigue, weight loss.
2. GIT symptoms:
   • Ascites.
   • Nausea, vomiting, anorexia.
   • Abdominal distension.
   • Splenomegaly.
   • Haematemesis.
   • Portal hypertension.
   • Nodular and enlarged liver.
3. Circulatory symptoms.
   • Palmar erythema, spider angiomata, cyanosis, clubbing.
4. Endocrine changes.
   • Loss of axillary and pubic hair, loss of libido, gynaecomastia, amenorrhoea.
5. Blood changes.
   • Aneamia, pancytopenia, bruises, purpura, epitaxis.

Cirrhosis of Liver Complications:

• Portal hypertension.
• Ascites
• Upper G1 bleeding
• Bacterial peritonitis.
• Hepatic encephalopathy n Hepatorenal syndrome.
• Hepatocellular carcinoma.

Cirrhosis of Liver Treatment:

1. Removal of causative agent.
2. General measures.
   • Intake of high protein and high caloric diet.
   • Avoid alcohol.
   • Vitamin and minerals supplements.
   • Low sodium diet.
   • Use of diuretics.
   • Water restriction.
3. Treatment of complications.
4. Liver transplantation.

Question 6. Define and describe the clinical features of ascites. Describe the pathogenesis and treatment of ascites.

Answer:

Ascites: An abnormal collection of fluid in the peritoneum is called ascites.

Pathogenesis:

1. Inflammation of peritoneum.

↓

Increased capillary permeability.

↓

Transudation of fluid into peritoneum

↓

Ascites

2. Venous obstruction

↓

Transudation of fluid into peritoneum

↓

Ascites

↓

Lymphatic obstruction → Ascites

Ascites Clinical Features:

• Abdominal enlargement.
• Stretching sensation
• Low back pain
• Indigestion, heartburn
• Dyspnoea or tachypnoea.
• Abdominal or inguinal hermia.
• Hepatosplenomegaly.

Ascites  Treatment:

• Salt restriction
• Use of diuretics
• Therapeutic paraentesis.
• Cefotaxime – 1g 4 twice a day.
• Gentamicin – 60 – 80 mg 4 or IM 8 hourly.