Liver+Disease

A. many different manifestations of liver dysfunction

Jaundice
1. yellowing of skin, sclera, and other tissues due to xs circulating bilirubin 2. bilirubin from breakdown of RBC’s 3. unconjugated (indirect) bilirubin transported in plasma bound to albumin and taken to liver 4. conjugated with glucuronic acid in liver to form conjugated (direct) bilirubin 5. then secreted into bile canaliculi to form bile 6. this then excreted in feces and urine 7. much reabsorbed and used again

a. inc bilirubin formation, impaired hepatic uptake,or decreased conjugation cause unconjugated hyperbilirubinemia b. impaired biliary excretion causes conjugated hyperbilirubinemia c. clinically often see mixed hyperbilirubinemia d. try to find where it is coming from 9. hemolysis, hepatocellular dysfunction, biliary obstruction
 * Pathology**

a. mild jaundice without dark urine is usually unconjugated hyperbili due to hemolysis or Gilbert’s syndrome b. deep jaundice or dark urine often hepatic or biliary disorder
 * Signs & Symptoms**

a. liver function tests b. US
 * Testing**

Cholestasis
1. impairment of bile flow 2. intrahepatic a. hepatitis, alcoholic liver disease, drug use 3. extrahepatic a. common bile duct stone, pancreatic carcinoma Signs & Symptoms a. jaundice, dark urine, pale stools, pruritis

Hepatomegaly
1. liver enlargement

Portal hypertension
1. inc portal vein pressure 2. cirrhosis most common cause 3. shunting of portal blood into systemic circulation ---high systemic concentrations of hormones and other substances usually extracted by liver - portal encephalopathy b. esophageal varices, caput medusae

Ascites
1. fluid in the peritoneal cavity 2. chronic disorders usually cirrhosis - low serum osmotic pressure from hypoalbuminemia - high portal venous pressure - abdominal discomfort - shifting dullness on abd percussion - fluid waves in advanced disease
 * pathology**
 * Signs & Symptoms**

Portal systemic encephalopathy
1. chronic liver disease 2. shunting of portal venous blood - personality changes - impaired consciousness - constructional apraxia - musty sweet odor to breath - asterixis: arms outstretched, wrists dorsiflexed; flapping tremor 4. hyperreflexia, + Babinski
 * Signs & Symptoms**