Liver is the largest internal organ of the body which is present on the right side of abdomen. It is a fleshy and rubbery organ, brown in colour, has an ability to regenerate and is responsible to control over 500 vital functions. It is responsible for exocrine, endocrine, absorptive functions, postabsorbative and immunological clotting functions . Liver helps in metabolizing nutrients from small intestine, it detoxifies harmful substances from bloodstream like drugs and alcohol. The organ produces proteins and stores nutrients, it secrets bile and helps in the metabolism of drugs. Any of the factors affecting the vital functions of liver can result in liver disease.
Most common liver diseases are fibrosis, cirrhosis and liver inflammation due to infections. Liver cirrhosis occurs due to scar tissue replacing normal liver cells because of chronic liver pathology. Symptoms of liver disease include weakness, fatigue, nausea, vomiting, weight loss, yellow discoloration of skin, yellow urine, pruritis, abdominal discomfort and pain, loss of appetite and inability to digest fatty food.
In cases of liver failure the symptoms are much worse and the patient may become confused, disoriented, and fatigued. This can lead to coma and sudden death . If liver diseases are treated at the very initial phase, then there is a good chance of the person recovering well. Biliary tract obstruction, cholelithiasis and cholecystitis are biliary tract problems which can predispose to metabolic disorders.
The various investigations of liver dysfunction include complete blood count (CBC), liver function tests, ferritin, hepatic enzymes, bilirubin, ammonia, lactate, blood gases, creatinine, free copper, phosphate, viral markers and drug screening. Biopsy, CT scan and MRI may also be useful to diagnose liver diseases.
Patients with acute liver failure develop circulatory dysfunction. Fluid and hemodynamic support should be provided to these patients. Noting down and keeping a record of metabolic parameters, infection control, proper nutrition, and observation of gastrointestinal bleeding if any are steps of management of various liver diseases. Clotting factors, complete blood cell count, and liver functions should be measured time to time . Serum aminotransferases and bilirubin are recorded daily to follow the pattern of the disease.
Antibiotics are given if liver disease due to infection. Penincillamine and zinc therapy are used in patients with metabolic diseases. Prednisone and azathioprine are given to suppress the immune system. Spironolactone and furesimide diuretics are used in patients with ascites. Lactulose and neomycin are employed to treat encephalopathy. Appropiate doses of vitamins help in the absorption of fat thus preventing fatty liver .
Prognosis of liver diseases is good in early detection of disease. Diet control and treating the underlying causes can help prevent liver dysfunction. Chronic cases like congenital anomalies, chronic liver failure and liver cirrhosis have a poor prognosis, where only intensive care can be provided to the patient by keeping a check over his liver functions and trying to improve the condition by supportive medication.
Cytomegalovirus is the major cause of liver infections in most cases of acute liver disease. Hepatitis is the major causes of chronic diseases of liver. Azathioprine is responsible for acute cholestasis, but could not be identified as a direct cause of chronic disease.
Other viruses and diseases affecting liver are adenoviruses, coxsackie virus, rubella, yellow fever, arena viruses and ebola virus disease. Bacterial, fungal, spirochetal infections, rickettsial infections and vascular disorders like arteriosclerosis, amyloidosis, aneurysms, infarcts, eclampsia may also affect the liver function. Drug induced liver injury, portal vein thrombosis, veno-occlusive diseases, congenital disorders, right and left heart failure are some of the abnormalities possibly affecting the liver. Graft-versus-Host reaction, hepatic autograft rejection, autoimmune cholangitis and idiopathic adulthood ductopenia may lead to liver function disorders .
The true reason for the liver disease precipitation is unknown; there can be many causes both external and internal that can induce liver diseases. Alcoholic liver diseases are common, which can cause liver cirrhosis and liver failure. Epidemiological studies vary quite a lot all over the world with respect to the prevalence and incidence of liver diseases. No predisposition in a particular population is found for liver diseases, but hepatitis B has an overall higher prevalence rate than hepatitis A and C in causing liver functional disorders .
General pathology of liver diseases include cellular changes, reaction to any injury, inflammation, repair, fibrosis, tissue changes and cholestasis. Liver pathology is seen in two basic patterns, one is dystrophy and the second is necrosis. If broadly classified, the different pathological presentation of liver in different conditions is as follows:
In liver cirrhosis, autoimmune cells are present comprising predominantly of T lymphocytes, bile duct damage and vanished bile ducts. Accumulation of lymphocytes, plasma cells and histolytic are seen in the portal area.
When copper gets deposited in the hepatocytes it results in Wilson’s disease, it also affects central nervous system and joints. Urea synthesis disorder can lead to the accumulation of urea and hepatic encephalopathy. Hepatocerebral coma may be a result of hepatic disease, toxic liver dystrophy and cirrhosis.
Disorders of bile production can lead to jaundice, steatorrohea and cholemia. In cholelithiasis, there is an obstruction of bile duct and elevated levels of conjugated bilirubin, predisposing to clay like stools and black colored urine.
Alcoholic liver disease is characterized by hepatocyte swelling and necrosis, Mallory body formation, fibrosis and neutrophilic reaction. Portal hypertension is characterized by caput medusa (varicose veins of abdomen), ascites and splenomegaly .
Stopping intake of alcohol and drug overuse can prevent progression of liver pathology. Vaccines should be administered in order to prevent occurrence of various types of hepatitis. Obesity and diabetes may cause fatty liver. Medicines should be used wisely. Contact should be avoided with people with infected blood and body fluids. Increase in body weight should be kept under check .
Classification of liver disease can be based on many types. Liver disease can be induced by variety of agents ranging from alcohol, drugs, infections, and hereditary causes. Infections may result from virus, bacteria and other pathogens.
Viral hepatitis (A, B, C, D and E) is a disease of major concern. Toxic agents like alcohol, drugs and environmental pollutants may also result in liver diseases. Autoimmune diseases and biliary cirrhosis cause liver injury. Autoimmune disease include Wilson's disease, Budd–Chairi syndrome, Chyle fistula, hemochromatosis, inborn error of metabolism, Antitrypsin 1 deficiency, and autoimmune hepatitis.
Hepatic cysts and hepatic hemangiomas are conditions which may result in liver malfunction. Benign neoplasm, malignant conditions, like hepatocellular carcinoma and adenoma, can also affect liver resulting in liver failure .
Definition: Liver disease is the dysfunction of any of the liver functions related to nutrition, absorption, digestion, blood clotting and toxin elimination. Any problem in the metabolic activities of liver relating to the vital functions of metabolism, clotting and immunogenicity may predispose to liver disease.
Cause: Causes of the liver disease can be alcohol overuse, drug misuse, obesity, diabetes, deficiency of multivitamins and obstruction of bile duct. Reasons of predisposition of liver disease can be hereditary which may include diseases like Wilson’s disease, Gilbert’s syndrome and antitrypsin deficiency. Other reasons are viral, bacterial and fungal infections.
Diagnosis: Diagnosis may be made by presenting symptoms like itching, yellow discoloration of skin. Liver function tests and other diagnostic measurements are used in diagnosing liver diseases. Some conditions may require liver biopsy and imaging studies.
Treatment: Antibiotics are given commonly in liver disease. Treatment with diuretics, and other drugs is according to the disease condition . Rifampin, naloxone, acetaminophen, azathioprine and multivitamins are other common drugs given in liver malfunction.