Hepato-biliary diseases
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
For the approach to a patient with liver disease, please click here.
Normal Liver
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Histopathological Findings of a Normal Liver
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Viral hepatitis
- Acute hepatitis A
- Acute hepatitis B
- Acute Hepatitis D
- Acute hepatitis C
- Acute hepatitis E
- Chronic viral hepatitis
- Other viral hepatitis viruses may exist but are not so firmly established as the previous ones: hepatitis G.
Histopathological Findings in Viral hepatitis
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Histopathological Findings in Viral hepatitis with Fulminant Necrosis
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Liver Dysfunction in other Infectious Diseases [1] [2]
- Hepatitis:
- Cytomegalovirus infection
- Herpesviral: Herpes simplex infection
- Toxoplasmosis
- Hepatosplenic schistosomiasis
- Portal hypertension in schistosomiasis
- Liver disease in syphilis
- Epstein-Barr virus infection
- Yellow fever virus infection
- Rubella virus infection
- Leptospirosis
- Echinococcosis
- Amoebiasis
Other Inflammatory Liver Diseases
- Liver abscess
- Autoimmune hepatitis
- Primary biliary cirrhosis
- Phlebitis of the portal vein
- Granulomatous hepatitis
- Hepatic granulomas in:
Alcoholic liver disease
This may cause fatty liver, hepatitis, fibrosis and sclerosis leading to cirrhosis and finally hepatic failure.
Histopathological Findings of Alcoholic Liver Disease
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Toxic Liver Disease
This includes mostly drug-induced hepatotoxicity, which may generate many different patterns over liver disease, including;
- Cholestasis
- Necrosis
- Acute hepatitis and chronic hepatitis of different forms,
- Cirrhosis
- Effects of Acetaminophen (Tylenol)
- Other rare disorders like focal nodular hyperplasia, hepatic granulomas, peliosis hepatis and veno-occlusive disease.
Liver damage is part of Reye's syndrome.
Histopathological Findings: Liver: Centrilobular Necrosis from Chloroform
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Liver tumors
Malignant neoplasm of liver and intrahepatic bile ducts. The most frequent forms are metastatic malignant neoplasm of liver)
- Liver cell carcinoma
- Cholangiocarcinoma
- Hepatoblastoma
- Angiosarcoma of liver
- Kupffer cell sarcoma
- Other sarcomas of liver
Benign neoplasm of liver include hepatic hemangiomas, hepatic adenomas, and focal nodular hyperplasia (FNH).
End-stage liver disease
Chronic liver diseases like chronic hepatitis, chronic alcohol abuse or chronic toxic liver disease may cause
- Hepatic failure and hepatorenal syndrome
- Fibrosis and cirrhosis of liver
Cirrhosis may also occur in primary biliary cirrhosis. Rarely, cirrhosis is congenital.
Metabolic diseases (Chapter E in ICD-10)
- Haemochromatosis
- Wilson's disease
- Gilbert's syndrome
- Crigler-Najjar syndrome
- Dubin-Johnson syndrome
- Rotor's syndrome
Vascular Disorders
- Chronic passive congestion of liver
- Central haemorrhagic necrosis of liver
- Infarction of liver
- Peliosis hepatis
- Veno-occlusive disease
- Portal hypertension
- Budd-Chiari syndrome
Cysts
- Congenital cystic disease of liver
- Cysts caused by Echinococcus
Others
Gallbladder and biliary tract diseases
- Malignant neoplasm of the gallbladder
- Malignant neoplasm of other parts of biliary tract
- Extrahepatic bile duct
- Ampulla of Vater
- Cholelithiasis
- Cholecystitis
- Others (excluding postcholecystectomy syndrome), but including
- Other obstructions of the gallbladder (like strictures
- Hydrops, perforation, fistula
- Cholesterolosis
- Biliary dyskinesia
- K83: other diseases of the biliary tract:
- Cholangitis (including ascending cholangitis and primary sclerosing cholangitis)
- Obstruction, perforation, fistula of biliary tract
- Spasm of sphincter of Oddi
- Biliary cyst
- Biliary atresia
Diagnosis
In hepatology, important signs and symptoms include:
- History of alcohol abuse
- Liver function tests
- Hepatomegaly
- Hypoalbuminemia and ascites
- Jaundice or icterus
- Murphy's sign
- Liver biopsy
Complete Differential Diagnosis of Causes of Hepato-biliary diseases
Autoimmune, Systemic
- Amyloidosis
- Autoimmune hepatitis
- Burns
- Chronic Myelogenous Leukemia
- Hodgkin's Lymphoma
- Hyperthermia
- Inflammatory Bowel Disease
- Non-Hodgkin's lymphoma
- Osteomyelofibrosis
- Polycythemia
- Primary Biliary Cirrhosis
- Primary sclerosing cholangitis
- Sarcoidosis
Cholestatic
Infection
- Amebiasis
- Ascaris lumbricoides
- Brucellosis
- Canine roundworm
- Coxsackie virus
- Cytomegalovirus
- Echinococcus granulosus
- Echinococcus multilocularis
- E.Coli
- Entamoeba histolytica
- Epstein-Barr Virus
- German Measles
- Hepatitis A-G
- Herpes simplex
- Human Herpesvirus Six (HHV6)
- Klebsiella
- Leptospirosis
- Liver flukes
- Malaria
- Measles
- Mumps
- Parainfluenza
- Plasmodium falciparum
- Plasmodium ovale
- Plasmodium vivax
- Proteus
- Rickettsia
- Rickettsiosis
- Rubella
- Salmonella
- Schistosoma japonicum
- Schistosoma mansoni
- Schistosomiasis
- Staphylococcus aureus
- Toxoplasma gondii
- Toxoplasmosis
- Trichinella spiralis
- Trypanosoma cruzi
- Tuberculosis
- Varicella zoster
- Yellow Fever
Liver Changes
- Abscess
- Adenomas
- Alcoholic Hepatitis
- Angiosarcoma
- Autoimmune hepatitis
- Biliary hepatitis
- Cholangiocarcinoma
- Chronic viral hepatitis
- Cirrhosis
- Colon Cancer
- Cysts
- Drug-induced hepatitis
- Fatty liver
- Focal nodular hyperplasia
- Gastric carcinoma
- Granulomatous hepatitis
- Hemangiomas
- Hematoma
- Hepatitis in systemic diseases
- Hepatocellular carcinoma
- Hepatomas
- Hodgkin's Lymphoma
- Non-Hodgkin's lymphoma
- Pancreatic Cancer
- Postoperative hematoma
- Trauma
- Wilson's Disease
Metabolic
- Alpha-1 Antitrypsin Deficiency
- Budd-Chiari Syndrome
- Congestive Heart Failure
- Constrictive pericarditis
- Cystic Fibrosis
- Drugs, toxins
- Fructose intolerance
- Galactosemia
- Gaucher's Disease
- Glycogenosis
- Hemochromatosis
- Histiocytosis X
- Hypertyrosinemia
- Hypothyroidism
- Hypoxia
- Inferior vena cava web
- Neimann-Pick Disease
- Protoporphyria
- Shock
- Thrombosis
- Tumor
- Wilson's Disease
Other
Treatment
Includes:
- Motivate patient to stop drinking alcohol
- Vaccination for hepatitis
- Eradication of causative pathogens
- Liver transplantion
- Cholecystectomy
Active liver disease is considered an absolute contraindication to the use of the following medications:
- Amlodipine besylate and Atorvastatin calcium trihydrate
- Methyldopa
- Rosuvastatin
- Hydroxyprogesterone caproate
Marked liver dysfunction is considered an absolute contraindication to the use of the following medications:
Liver dysfunction is considered an absolute contraindication to the use of the following medications:
Histopathological Findings in Liver Diseases
Liver: Cryptococcosis
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Liver: Cytomegalic inclusion disease
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Liver: Echinococcus cyst
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Liver: Histoplasmosis
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Liver & Spleen in Malaria
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Liver: Alpha-1-antitrypsin deficiency
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Liver: Cardiac sclerosis (cardiac cirrhosis)
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Liver: Centrilobular necrosis from chloroform
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Liver: Chronic active hepatitis, cirrhosis
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Liver: Cirrhosis (micronodular)
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Liver: Congenital cytomegalovirus disease
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Liver: Erythroblastosis fetalis
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Fulminant hepatitis (massive hepatic necrosis)
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Liver: Hepatitis, yellow fever virus
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Herpes hepatitis
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Liver: Traumatic hemorrhage
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Liver: Viral hepatitis
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Liver: Viral hepatitis with fulminant necrosis
Fulminant hepatitis (massive hepatic necrosis) is an acute liver failure (<1 month) resulting in rapid hepatic compensation characterized by synthetic dysfunction (hypoglycemia, coagulopathy), coma (cerebral edema, hepatic encephalopathy) and associated with infectious, renal, pulmonary and metabolic complications.
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Active liver disease is considered an absolute contraindication to the use of the following medications:
Liver: Wilson disease
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