Hepato-biliary diseases: Difference between revisions
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'''For the approach to a patient with liver disease, please click [[Approach to a patient with liver disease|here]].''' | |||
==Normal Liver== | ==Normal Liver== | ||
{| | |||
|- | |||
Image:Livertop.jpg|View of Liver from the top | | [[Image:Livertop.jpg|View of Liver from the top]] || [[Image:Liverbottom.jpg|View of Liver from the bottom]] | ||
Image:Liverbottom.jpg|View of Liver from the bottom | |} | ||
=== Histopathological Findings of a Normal Liver=== | === Histopathological Findings of a Normal Liver=== | ||
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{{#ev:youtube|l4m3f2KCxLM}} | {{#ev:youtube|l4m3f2KCxLM}} | ||
==Liver | ==Liver Dysfunction in other Infectious Diseases <small> <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref></small>== | ||
* [[Hepatitis]]: | * [[Hepatitis]]: | ||
** [[ | ** [[Cytomegalovirus|Cytomegalovirus infection]] | ||
** | ** Herpesviral: [[herpes simplex|Herpes simplex infection]] | ||
* [[Toxoplasmosis]] | * [[Toxoplasmosis]] | ||
* [[ | * [[Schistosomiasis|Hepatosplenic schistosomiasis]] | ||
* [[Portal hypertension]] in [[schistosomiasis]] | * [[Portal hypertension]] in [[schistosomiasis]] | ||
* [[ | * [[Syphilis|Liver disease in syphilis]] | ||
* [[Epstein-Barr virus|Epstein-Barr virus infection]] | * [[Epstein-Barr virus|Epstein-Barr virus infection]] | ||
* [[ | * [[Yellow fever|Yellow fever virus infection]] | ||
* [[ | * [[Rubella|Rubella virus infection]] | ||
* [[ | * [[Leptospirosis]] | ||
* [[Echinococcosis]] | * [[Echinococcosis]] | ||
* [[Amoebiasis]] | * [[Amoebiasis]] | ||
==Other | ==Other Inflammatory Liver Diseases== | ||
* [[ | * [[Liver abscess]] | ||
* [[ | * [[Autoimmune hepatitis]] | ||
* [[ | * [[Primary biliary cirrhosis]] | ||
* [[ | * [[Phlebitis]] of the [[portal vein]] | ||
* Granulomatous hepatitis | * Granulomatous hepatitis | ||
* Hepatic granulomas in: | * Hepatic granulomas in: | ||
** [[ | ** [[Berylliosis]] | ||
** [[ | ** [[Sarcoidosis]] | ||
==Alcoholic liver disease== | ==Alcoholic liver disease== | ||
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{{#ev:youtube|EBpeeIxuMuk}} | {{#ev:youtube|EBpeeIxuMuk}} | ||
==[[Toxic | ==[[Toxic Liver Disease]]== | ||
This includes mostly drug-induced [[hepatotoxicity]], which may generate many different patterns over liver disease, including | 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]] | ||
* [http://www.medicinenet.com/tylenol_liver_damage/article.htm Effects of Acetaminophen (Tylenol)] | * [http://www.medicinenet.com/tylenol_liver_damage/article.htm 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]]. | Liver damage is part of [[Reye's syndrome]]. | ||
| Line 87: | Line 84: | ||
==Liver tumors== | ==Liver tumors== | ||
Malignant [[liver tumour|neoplasm of liver]] and intrahepatic bile ducts. The most frequent forms are [[metastatic]] malignant neoplasm of liver) | Malignant [[liver tumour|neoplasm of liver]] and intrahepatic bile ducts. The most frequent forms are [[metastatic]] malignant neoplasm of liver) | ||
* | * Liver cell carcinoma | ||
** [[ | ** [[Hepatocellular carcinoma]] | ||
** [[ | ** [[Hepatoma]] | ||
* [[ | * [[Cholangiocarcinoma]] | ||
* [[ | * [[Hepatoblastoma]] | ||
* [[ | * [[Angiosarcoma]] of liver | ||
* [[Kupffer cell]] sarcoma | * [[Kupffer cell]] sarcoma | ||
* | * Other sarcomas of liver | ||
Benign [[liver tumour|neoplasm of liver]] include hepatic hemangiomas, [[Adenoma#Liver|hepatic adenoma]]s, and [[focal nodular hyperplasia]] (FNH). | Benign [[liver tumour|neoplasm of liver]] include hepatic hemangiomas, [[Adenoma#Liver|hepatic adenoma]]s, and [[focal nodular hyperplasia]] (FNH). | ||
==End-stage liver disease== | ==End-stage liver disease== | ||
Chronic liver | [[Chronic liver disease]]s like [[chronic hepatitis]], chronic [[alcohol abuse]] or chronic [[hepatotoxicity|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. | [[Cirrhosis]] may also occur in [[primary biliary cirrhosis]]. Rarely, [[cirrhosis]] is congenital. | ||
==Metabolic diseases | ==Metabolic diseases (Chapter E in ICD-10)== | ||
* [[Haemochromatosis]] | |||
* [[Wilson's disease]] | |||
* [[Gilbert's syndrome]] | |||
* [[Crigler-Najjar syndrome]] | |||
* [[Dubin-Johnson syndrome]] | |||
* [[Rotor's syndrome]] | |||
==Vascular | ==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]] | * [[Budd-Chiari syndrome]] | ||
==Cysts== | ==Cysts== | ||
* [[ | * [[Congenital]] cystic disease of liver | ||
* [[Cyst]]s caused by [[Echinococcus]] | * [[Cyst]]s caused by [[Echinococcus]] | ||
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==Gallbladder and biliary tract diseases== | ==Gallbladder and biliary tract diseases== | ||
* [[ | * [[Malignant]] [[Gall bladder#Gallbladder Cancer|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]]: | * 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= | =Diagnosis= | ||
In hepatology, important [[signs]] and [[symptoms]] include: | In hepatology, important [[signs]] and [[symptoms]] include: | ||
* | * History of [[alcohol abuse]] | ||
* [[Liver function tests]] | * [[Liver function tests]] | ||
* [[Hepatomegaly]] | * [[Hepatomegaly]] | ||
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* [[Liver#Liver transplantation|Liver transplantion]] | * [[Liver#Liver transplantation|Liver transplantion]] | ||
* [[Cholecystectomy]] | * [[Cholecystectomy]] | ||
{{MedCondContrAbs|MedCond = Active liver disease|Amlodipine besylate and Atorvastatin calcium trihydrate|Methyldopa|Rosuvastatin|Hydroxyprogesterone caproate}} | |||
{{MedCondContrAbs|MedCond = Marked liver dysfunction|Danazol|Methazolamide}} | |||
{{MedCondContrAbs|MedCond = Liver dysfunction|Clomifene|Medroxyprogesterone|Progesterone}} | |||
==Histopathological Findings in Liver Diseases== | ==Histopathological Findings in Liver Diseases== | ||
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{{#ev:youtube|l4m3f2KCxLM}} | {{#ev:youtube|l4m3f2KCxLM}} | ||
{{MedCondContrAbs|MedCond = Active liver disease|Rosuvastatin}} | |||
=== [[Liver]]: [[Wilson disease]]=== | === [[Liver]]: [[Wilson disease]]=== | ||
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{{Reflist|2}} | {{Reflist|2}} | ||
{{Gastroenterology}} | |||
{{WH}} | |||
{{WS}} | |||
[[tr:Karaciğer ve Safra Kesesi Hastalıkları]] | |||
[[Category:Gastroenterology]] | [[Category:Gastroenterology]] | ||
[[Category:Hepatology]] | [[Category:Hepatology]] | ||
Latest revision as of 22:07, 29 July 2020
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
 |
|
Histopathological Findings of a Normal Liver
{{#ev:youtube|eWME5fnIofs}}
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
{{#ev:youtube|_hXvbpSxFZw}}
Histopathological Findings in Viral hepatitis with Fulminant Necrosis
{{#ev:youtube|l4m3f2KCxLM}}
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
{{#ev:youtube|EBpeeIxuMuk}}
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
{{#ev:youtube|yKgd5fuHXvo}}
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
{{#ev:youtube|QHJijnGknLM}}
Liver: Cytomegalic inclusion disease
{{#ev:youtube|mRb8o-Adqa4}}
Liver: Echinococcus cyst
{{#ev:youtube|ANUbdXpzcNc}}
Liver: Histoplasmosis
{{#ev:youtube|uzoQEtQb7Ng}}
Liver & Spleen in Malaria
{{#ev:youtube|zrdPA9BJ2xU}}
Liver: Alpha-1-antitrypsin deficiency
{{#ev:youtube|YxB04tGvqd0}}
Liver: Cardiac sclerosis (cardiac cirrhosis)
{{#ev:youtube|a2L6gwoOw70}}
Liver: Centrilobular necrosis from chloroform
{{#ev:youtube|yKgd5fuHXvo}}
Liver: Chronic active hepatitis, cirrhosis
{{#ev:youtube|CzKGvWZrUpU}}
Liver: Cirrhosis (micronodular)
{{#ev:youtube|CV8OYeIUXko}}
Liver: Congenital cytomegalovirus disease
{{#ev:youtube|Daz7gH0kYY0}}
Liver: Erythroblastosis fetalis
{{#ev:youtube|eGvN-lnTUYU}}
Fulminant hepatitis (massive hepatic necrosis)
{{#ev:youtube|G5G9AnVhqhI}}
Liver: Hepatitis, yellow fever virus
{{#ev:youtube|YvraLxq6S8w}}
Herpes hepatitis
{{#ev:youtube|9nXYYz6SQio}}
Liver: Traumatic hemorrhage
{{#ev:youtube|dx6BesX27c0}}
Liver: Viral hepatitis
{{#ev:youtube|_hXvbpSxFZw}}
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.
{{#ev:youtube|l4m3f2KCxLM}}
Active liver disease is considered an absolute contraindication to the use of the following medications:
Liver: Wilson disease
{{#ev:youtube|ussRBz7O-vs}}