Disease Of The Hepatobiliary System Short Essays

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Disease Of The Hepatobiliary System Important Notes

  1. Hepatic Carcinoma
    • Hepatic Carcinoma is cancer of the liver
    • Hepatic Carcinoma Etiology
      • Hepatitis B and C
      • Cirrhosis of liver
      • Wilsons disease
      • Haemochromatosis
      • Estrogen and androgen
      • Anabolic steroids
      • Alcohol
    • Hepatic Carcinoma Clinical Features
      • Yellow skin
      • Bloating from fluid in the abdomen
      • Easy bruising
      • Loss of appetite
      • Weight loss
      • Abdominal pain
      • Nausea, vomiting
      • Fatigue
      • Polycythemia
      • Hypoglycaemia
      • Hypercalcemia
  2.  Liver Abscess
    • It is a pus-filled mass inside the liver
    • Liver Abscess Etiology
      • Portal vein bacteremia
      • Systemic bacteremia
      • Ascending cholangitis
      • Penetrating trauma
      • Direct extension from focus of infection
    • Liver Abscess Clinical features
      • Jaundice
      • Abdominal pain
      • Nausea, vomiting
      • Dark urine
      • Clay-colored stools
      • Fever with chills
      • Loss of appetite
      • Weight loss
      • Weakness
  3. Jaundice
    • The yellow pigmentation of the skin, mucous membrane & deeper tissues due to increased bilirubin levels in blood is called jaundice
    • It occurs when the bilirubin level exceeds 2 mg%
    • Jaundice Types:Disease Of the Hepatobiliary System Jaundice Types
  4. Cirrhosis Of The Liver – Features
    • Jaundice
    • Hepatomegaly
    • Ascites
    • Spider telangiectasia
    • Loss of libido
    • Gynaecomastia
    • Bruises, epistaxis
    • Portal hypertension
    • Clubbing
  5. Ascites
    • It is an abnormal collection of fluid in the peritoneum
    • Clinical features
      • Abdominal enlargement
      • Stretching sensation
      • Low back pain
      • Indigestion
      • Heart bum
      • Dyspnoea or tachypnoea
      • Abdominal or inguinal hernia
      • Hepatosplenomegaly
  6. Ascitic Fluid In Different DiseasesDisease Of the Hepatobiliary System Ascitic Fluid IOn Different Diseases
  7. Hepatic Encephalopathy
    • It is a neuropsychiatric syndrome caused by liver disease
    • Precipitating factors
      • Infection
      • Hypokalaemia
      • Constipation
      • GI bleeding
      • Dehydration
      • Drug
      • Trauma
  8. Hepatomegaly
    • Hepatomegaly Cause
      • Hepatomegaly Vascular
        • Congestive cardiac failure
        • Hepatic vein thrombosis
        • Hemolytic anemia
      • Hepatomegaly Bile duct obstruction
        • Stone
        • Tumour
      • Hepatomegaly Infiltrative
        • leukemia
        • Lymphoma
        • Fatty liver
        • Fat storage disease
        • Amyloidosis

Read And Learn More: General Medicine Question and Answers

      • Parasitic
        • Malaria
        • Kala-azar
        • Hydatid disease
      • Inflammatory
        • Hepatitis
        • Typhoid fever
      • Tumor
      • Rare
        • Polycystic disease of the liver
  2. Types Of Liver Enlargement
    Disease Of the Hepatobiliary System Types Of Liver Enlargement
  3. Splenomegaly
    • Splenomegaly Causes
      • Infection
        • Bacterial – endocarditis, tuberculosis
        • Viral – hepatitis, AIDS
        • Protozoal – malaria
        • Spirochaetal – syphilis
        • Fungal – Histoplasmosis
      • Inflammatory
        • Rheumatoid arthritis
        • Sarcoidosis
      • Congestive splenomegaly
        • Portal hypertension
        • Hepatic vein thrombosis
        • Pericardial effusion
      • Hemolytic disorders
        • Spherocytosis
        • Thalassaemia
      • Infiltrative diseases
        • Amyloidosis
        • Acute leukemia
      • Miscellaneous
        • Iron deficiency anemia
        • Idiopathic
        • Sarcoidosis

Disease Of The Hepatobiliary System Short Essays

Question 1. Hepatitis A.

Answer:

Hepatitis A

It is caused by the Hepatitis A virus.

Hepatitis A Mode of Transmission:

  • Faeco-oral route.
  • Contaminated water and milk.
  • Blood transfusion.
  • Homosexual activity.

Hepatitis A Clinical Features:

  1. Incubation period 15-45 days.
    • Prodromal symptoms – Anicteric phase.
    • Icteric phase.
    • Recovery phase.

Hepatitis A Investigations:

  1. Serum transaminases – Rises.
  2. Serum bilirubin – Rises (5 – 20 mg %)
  3. Leucocytosis, neutropenia.
  4. Prothrombin time – normal or prolonged.
  5. Scrum alkaline phosphatase – normal.
  6. Urine urobilinogen – Increased.
  7. Bile salts and bile pigments – Appears in urine.
  8. Ultrasound – shows an enlarged liver.

Hepatitis A Treatment:

  • Bed rest.
  • High protein and high carbohydrate intake.
  • 4 glucose administration. n Avoid hepatotoxic drugs.
  • Use of H2 blockers and antacids.

Question 2. Hepatitis E.

Answer:

Hepatitis E

Hepatitis E is caused by hepatitis E virus.

Hepatitis E Etiology:

  • Poor hygiene and sanitation.
  • Mode of transmission – Faeco – oral route.

Hepatitis E Clinical Features:

  • Incubation period – 3 – 8 weeks.
  • Hepatitis E does not progress to chronicity.

Hepatitis E Diagnosis:

  • Detection of anti-HEV antibodies,
    • IgM – during the early phase.
    • IgG – after recovery.

Question 3. Chronic active hepatitis.

Answer:

Chronic active hepatitis

Chronic hepatitis is defined as any hepatitis lasting 6 months or longer.

Chronic active hepatitis Causes:

  1. Infective.
    • Hepatitis B, C, and D.
  2. Toxic.
    • Drugs – alpha – methyldopa, isoniazid.
    • Alcohol.
  3. Metabolic.
    • Hemochromatosis.
    • Wilson’s disease.
  4. Other
    • Autoimmune hepatitis.

Disease Of the Hepatobiliary System Chronic Active Hepatitis

Question 4. Discuss the etiology and clinical features of ascites.

Answer:

Ascites: Abnormal collection of fluid in peritoneum e c.tll< d ascites.

Ascites Etiology:

  1. Systemic causes.
    • Nephrotic syndrome.
    • Cirrhosis of liver
    • Hypoproteinaemia.
    • Congestive cardiac failure.
    • Malignancy of the liver.
  2. Local causes.
    • Peritonitis
    • Tuberculosis.
    • Pancreatitis.

Ascites  Clinical Features: 

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

Question 5. Complications Of Hepatitis B 

Answer:

Complications Of Hepatitis B

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

Question 6. Obstructive jaundice – investigation.

Answer:

Obstructive jaundice – investigation

  1. Hemoglobin level – normal.
  2. Bile Salts and bile pigment.
    • Present in urine
    • Absent in stools
  3. Bilirubin – raised, conjugated.
  4. Serum cholesterol – raised.
  5. Serum alkaline phosphate – raised
  6. Serum transaminase – mildly raised.
  7. USG – shows dilatation of intrahepatic and extra-hepatic biliary system.

Disease Of The Hepatobiliary System Cholestatic Pattern Of LFTs

Question 7. Hepatomegaly.

Answer:

Hepatomegaly

Enlargement of the liver is called hepatomegaly.

Hepatomegaly Causes:

  1. Vascular changes.
    • Congestive cardiac failure.
    • hepatic vein thrombosis
    • hemolytic anemia.
  2. Bile duct obstruction
    • Due to stone, tumour.
  3. Infiltrative causes.
    • leukaemia.
    • Lymphoma
    • Fatty liver
    • Amyloidosis.
  4. Parasitic infection.
    • Malaria
    • Kala-azar
    • Amoebic liver abscess
  5. Inflammatory disease
    • hepatitis
    • Typhoid fever.
  6. Tumors
    • Primary or secondary in River.

Question 8. Tender hepatomegaly – causes.

Answer:

Tender Hepatomegaly Causes:

  • Hepatitis
  • Malignancy
  • Hepatic vein thrombosis
  • Congestive cardiac failure
  • Constrictive pericarditis.

Question 9. Hepatitis B – prevention.

Answer:

Hepatitis B – prevention

Two HBV vaccines are available.

  1. Recombivax HB
  2. Engerix – B
    • 3 injections of it are administered over six months.

Hepatitis B – Prevention Recommended For:

  • All infants at birth
  • Children – 18 years or above who have not been vaccinated previously.
  • Anyone who is undergoing treatment for sexually transmitted disease.
  • Injection drug users.
  • People with chronic liver diseases
  • Residents and staff for developmentally disabled individuals.
  • Hemodialysis patients.
  • People living with HIV.

Question 10.  Hepatitis C.

Answer:

Hepatitis C

Caused by hepatitis C, RNA virus.

Hepatitis C Route of Transmission:

  • Blood transfusions.
  • 4 drug user
  • Sexual transmission.

Hepatitis C Clinical Features:

  • Incubation period – 45 – 50 days.
  • Insidious in onset.
  • Produces moderate hepatitis.
  • Occurs in all age groups.
  • It leads to.
    • Vasculitis.
    • Arthritis
    • Glomerulonephritis.
    • Cryoglobulinaemia.
  • Its chronicity leads to
    • Cirrhosis of liver
    • Hepatocellular carcinoma
    • Liver failure.

Question 11. Complications of cirrhosis of the liver.

Answer:

Complications Of Cirrhosis Of The Liver

  • Portal hypertension
  • Hepatic
  • encephalopathy
  • Hepatorenal syndrome.
  • Hepatic cell carcinoma.
  • Fulminant septicaemia.
  • Fatal bleeding.
  • Peritonitis.

Question 12. Portal hypertension.

Answer:

Complications Of Cirrhosis Of The Liver

Complications Of Cirrhosis Of The Liver is defined as prolonged elevation of portal venous pressure above normal levels.

Portal Hypertension Causes:

  1. Prehepatic causes.
    • Portal vein thrombosis.
  2. Intrahepatic causes.
    • Cirrhosis.
    • Congenital hepatic fibrosis.
    • Drugs.
    • Sarcoidosis.
    • Secondaries in the liver.
  3. Post hepatic causes.
    • Budd-Chiari syndrome
    • Right heart failure.

Portal Hypertension Clinical Features:

  • Haemetemesis or malena.
  • Ascites,
  • Splenomegaly.
  • Fetor hepaticus.
  • Chronic hepatic encephalopathy.

Question 13. Hepatic encephalopathy.

Answer:

Hepatic Encephalopathy

Hepatic Encephalopathy is a syndrome of mental and neurological features that occur in patients with long-standing cirrhosis with or without portal hypertension.

Hepatic Encephalopathy Clinical Features:

  • Impaired celebration.
  • Moderate to severe jaundice.
  • Fetor hepaticus.
  • Flapping tremors.
  • Cirrhosis.
  • Portal hypertension.
  • Fever
  • Tachycardia.
  • Hyperventilation.
  • Hypotension.

Question 14. Spider nevi.

Answer:

Spider Nevi is one of the features occurring due to arteriolar changes induced hyperestrogenism.

  • They are dilated central arterioles with radiating small vessels.

Spider Nevi Parts Involved:

  • Parts drained by superior vena cava.
    • Head
    • Neck
    • Upper limbs
    • Front and back of the chest.
  • Size: Varies from 1- 2 mm to 1 – 2 cm in diameter.
  • Seen In:
    • Cirrhosis of liver
    • Chronic hepatic dysfunction.

Question 15. Splenomegaly-causes.

Answer:

Splenomegaly-Causes

  1.  Infective disorders.
    • Bacterial – Endocarditis, tuberculosis, septicaemia.
    • Viral – Hepatitis, AIDS.
    • Protozoal malaria.
    • Spirochaetal – syphilis.
    • Fungal – Histoplasmosis.
  2. Inflammatory disorders.
    • Rheumatoid arthritis, sarcoidosis.
  3. Congestive splenomegaly.
    • Portal hypertension.
    • Hepatic vein thrombosis.
    • Pericardial effusion.
  4. Hemolytic disorders.
    • Spherocytosis, thalassemia.
  5. Infiltrative diseases.
    • Amyloidosis.
    • Gaucher’s disease
    • Aclucleukemia.
  6. Miscellaneous.
  7. Iron deficiency anemia.
  8. Idiopathic
  9. Sarcoidosis.

VIVA VOCE

  1. Glucose is stored in the liver in the form of glycogen
  2. The liver utilizes amino acids for endogenous protein synthesis and plasma protein synthesis
  3. Conjugation of unconjugated bilirubin occurs in liver cells with the help of glucuronyltrans- phrase
  4. Kupffer cells are derived from blood monocytes and have immunological functions
  5. Normal bilirubin level – 0.3-1.0 mg/dl
  6. Normal alkaline phosphatase level – 25-115 U/L
  7. Normal acid phosphatase level – 1-5 U/l
  8. The normal prothrombin time index is 100%
  9. Transudative ascites is seen in cirrhosis of the liver
  10. Blood-stained ascites are seen in malignant infiltration of the peritoneum
  11. Milky ascites is seen in ductal obstruction
  12. Exudative ascites are seen in TB, malignancy, and hepatic vein obstruction
  13. Serum bilirubin level more than 2.5 mg/dl leads to jaundice
  14. Potassium-sparing diuretics are used in ascites
  15. Budd Chiari syndrome occurs from occlusion of the hepatic vein
  16. Collection of fluid more than 300 ml in the peritoneum leads to ascites

 

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