Aid in absorption of digested fat --> intestinal mucosal membrane
Excretion of waste product from the blood including bilirubin & cholesterol
Jaundice
What is it ?
A medical condition with yellowing of the skin or whites
of the eyes, arising from excess of the pigment bilirubin
and typically caused by obstruction of the bile duct, by
liver disease, or by excessive breakdown of red blood cells.
Signs & Symptoms
A yellow tinge to the skin and the
whites of the eyes, normally
starting at the head and
spreading down the body
Pale stools
Dark urine
Itchiness
Fatigue
Abdominal pain
Weight loss
Vomiting
Fever
Types
Pre-Hepatic
Haemolytic anaemia
Gilbert’s syndrome
Criggler-Najjar syndrome
Hepatocellular
Alcoholic liver disease
Viral hepatitis
Epidemiology
HAV -- Developing countries with poor sanitary conditions and hygienic practices
HBC -- Western Pacific Region and the WHO African Region
HCV -- Eastern Mediterranean and European Regions
HDV -- Mediterranean, Middle East, Pakistan, Central and Northern Asia, Japan, Taiwan, Greenland and parts of Africa
HEV -- Resource-poor areas with frequent water contamination
What is it?
Hepatitis means inflammation of the liver. Many illnesses and conditions can cause inflammation of
the liver, for example, drugs, alcohol, chemicals, and autoimmune diseases.
Types
Pathophysiology
CD8 cells attack virally-infected hepatocytes and induce apoptosis
So there is infiltration of lymphocytes ( CD8)
Persistent inflammation : will lead to fibrosis : chronic hepatitis: post-necrotic cirrhosis
Prognosis
Lab investigations
Liver Function Test
Total Bilirubin
CB
UCB
Serum Albumin
Total Protein
Serum Globulin
Alanine Aminotransferase
Alanine Phosphatase
Gamma GT
Prothrombin Time
Urea, Electrolytes, and creatinine
CBC/WBC
Hepatitis serological markers:
Complications
Fulminant hepatitis
Scarring of the liver (cirrhosis).
Liver cancer
Liver failure
Kidney failure
Vasulitis
Management
HBV
Lamivudine
A cytosine analogue- Nucleoside Reverse Transcriptase Inhibitor (NRTI)
Side effects
Headache, nausea, diarrhea, dizziness, myalgia, and malaise are rare
Co-infection with HIV may increase the risk of pancreatitis
Adefovir
An analog of adenosine monophosphate
Side effects
Nephrotoxicity
Lactic acidosis
Entecavir
An analog of guanosine monophosphate
Side effects
Potential adverse events are headache, fatigue, dizziness, nausea, rash, and fever.
Lung adenomas and carcinomas in mice, hepatic adenomas and carcinomas in rats and mice,
vascular tumors in mice, and brain gliomas and skin fibromas in rats have been observed at varying
exposures.
HCV
Ribavirin
A guanosine analogue
Side effects
Hemolytic anemia
Boceprevir
Telarprevir
Direct acting anti-viral agents
Daclatsevir
Direct acting anti-viral agent
Sofosbuvir
Sofosbuvir is a nucleotide analog that inhibits the HCV NS5B RNA-dependent RNA polymerase in
patients infected with HCV genotype 1, 2, 3, or 4.
Pegylated Interferon
Their metabolism and excretion mainly by the kidneys, where they undergo rapid proteolysis during
tubular reabsorption, so detection in the systemic circulation is negligible
Side effects
fFu-like symptoms
Bone depression
Medication
Hereditary haemochromatosis
Autoimmune hepatitis
Primary biliary cirrhosis
Hepatocellular carcinoma
Primary sclerosing cholangitis
Post-Hepatic
Intra-luminal causes, such as gallstones
Mural causes, such as cholangiocarcinoma, strictures, or drug-induced cholestasis
Extra-mural causes, such as pancreatic cancer or abdominal masses (e.g. lymphomas)