View by:

Hepatic and Biliary Disorders

Approach to the Patient With Liver Disease
Testing for Hepatic and Biliary Disorders
Alcoholic Liver Disease
- Alcoholic Liver Disease
Drugs and the Liver
- Effects of Liver Disease on Drug Metabolism
- Liver Injury Caused by Drugs
Fibrosis and Cirrhosis

Gallbladder and Bile Duct Disorders
Hepatitis
Liver Masses and Granulomas
Vascular Disorders of the Liver

Most liver disorders cause some degree of damage to the liver, resulting in various abnormal laboratory test results and, sometimes, symptoms. Symptoms may be due to liver disease itself or to complications of liver disease. Gallbladder and biliary tract disorders are also under the umbrella of hepatic disorders. The part of the hepatobiliary system affected determines what symptoms, signs, and laboratory abnormalities manifest.

Hepatic and Biliary DisordersSections (A-Z)

Alcoholic Liver Disease

(See also the 2010 American College of Gastroenterology’s practice guidelines for Alcoholic Liver Disease .)

Alcoholic Liver Disease

Approach to the Patient With Liver Disease

The liver is the most metabolically complex organ. Hepatocytes (liver parenchymal cells) perform the liver’s metabolic functions:

Liver Structure and Function
Evaluation of the Patient With a Liver Disorder
The Asymptomatic Patient With Abnormal Laboratory Test Results
Acute Liver Failure
Ascites
Crigler-Najjar Syndrome
Fatty Liver
Gilbert Syndrome
Inborn Metabolic Disorders Causing Hyperbilirubinemia
Jaundice
Nonalcoholic Steatohepatitis (NASH)
Portal Hypertension
Portosystemic Encephalopathy
Spontaneous Bacterial Peritonitis (SBP)
Postoperative Liver Dysfunction
Systemic Abnormalities in Liver Disease

Drugs and the Liver

Liver disease may have complex effects on drug clearance, biotransformation, and pharmacokinetics . Pathogenetic factors include alterations in intestinal absorption, plasma protein binding, hepatic extraction ratio, liver blood flow, portal-systemic shunting, biliary excretion, enterohepatic circulation, and renal clearance. Sometimes alterations increase levels of bioavailable drug, causing normal drug doses to have toxic effects. However, levels and effects for an individual drug are unpredictable and do not correlate well with the type of liver injury, its severity, or liver function test results. Thus, no general rules are available for modifying drug dosage in patients with liver disease.

Effects of Liver Disease on Drug Metabolism
Liver Injury Caused by Drugs

Fibrosis and Cirrhosis

Hepatic fibrosis is overly exuberant wound healing in which excessive connective tissue builds up in the liver. The extracellular matrix is overproduced, degraded deficiently, or both. The trigger is chronic injury, especially if there is an inflammatory component. Fibrosis itself causes no symptoms but can lead to portal hypertension (the scarring distorts blood flow through the liver) or cirrhosis (the scarring results in disruption of normal hepatic architecture and liver dysfunction). Diagnosis is based on liver biopsy. Treatment involves correcting the underlying condition when possible.

Hepatic Fibrosis
Cirrhosis
Primary Biliary Cirrhosis (PBC)

Gallbladder and Bile Duct Disorders

The liver produces about 500 to 600 mL of bile each day. Bile is isosmotic with plasma and consists primarily of water and electrolytes but also organic compounds: bile salts, phospholipids (mostly lecithin), cholesterol, bilirubin, and other endogenously produced or ingested compounds, such as proteins that regulate GI function and drugs or their metabolites. Bilirubin is a degradation product of heme compounds from worn-out RBCs and is the pigment that gives bile its yellow-green color.

Overview of Biliary Function
Acalculous Biliary Pain
AIDS Cholangiopathy
Acute Cholecystitis
Chronic Cholecystitis
Choledocholithiasis and Cholangitis
Cholelithiasis
Postcholecystectomy Syndrome
Primary Sclerosing Cholangitis (PSC)
Sclerosing Cholangitis
Tumors of the Gallbladder and Bile Ducts

Hepatitis

Hepatitis is an inflammation of the liver characterized by diffuse or patchy necrosis.

Causes of Hepatitis
Overview of Acute Viral Hepatitis
Fulminant Hepatitis
Overview of Chronic Hepatitis
Hepatitis A, Acute
Hepatitis B, Acute
Hepatitis B, Chronic
Hepatitis C, Acute
Hepatitis C, Chronic
Hepatitis D
Hepatitis E

Liver Masses and Granulomas

Isolated cysts are commonly detected incidentally on abdominal ultrasonography or CT (1) . These cysts are usually asymptomatic and have no clinical significance. The rare congenital polycystic liver is commonly associated with polycystic disease of the kidneys and other organs. It causes progressive nodular hepatomegaly (sometimes massive) in adults. Nevertheless, hepatocellular function is remarkably well preserved, and portal hypertension rarely develops.

Hepatic Cysts
Hepatic Granulomas
Benign Liver Tumors
Hepatocellular Carcinoma
Primary Liver Cancer
Metastatic Liver Cancer

Testing for Hepatic and Biliary Disorders

(See also the American Gastroenterological Association Medical Position Statement and Technical Review on evaluation of liver chemistry tests.)

Laboratory Tests of the Liver and Gallbladder
Imaging Tests of the Liver and Gallbladder
Liver Biopsy

Vascular Disorders of the Liver

The liver has a dual blood supply. The portal vein (which is rich in nutrients and relatively high in oxygen) provides two thirds of blood flow to the liver. The hepatic artery (which is oxygen-rich) supplies the rest. The hepatic veins drain the liver into the inferior vena cava. When portal vein blood flow increases, hepatic artery flow decreases and vice versa (the hepatic arterial buffer response). This dual, reciprocally compensatory, blood supply provides some protection from hepatic ischemia in healthy people.

Overview of Vascular Disorders of the Liver
Budd-Chiari Syndrome
Congestive Hepatopathy
Hepatic Artery Aneurysms
Hepatic Artery Occlusion
Ischemic Cholangiopathy
Ischemic Hepatitis
Peliosis Hepatis
Portal Vein Thrombosis
Veno-Occlusive Disease

View by:

Also of Interest

Test your knowledge

Which of the following develops in about 75% of patients with nonalcoholic steatohepatitis (NASH)?

Cirrhosis Cytopenia Hepatomegaly Portal hypertension

STUDENTSTORIES
A MEDICAL EDUCATION BLOG

Avni

Human Touch in the World of Medicine

Throughout your time in medical school, especially during your third and fourth year, you’ll find yourself somewhere in the hospital. You’ll get used...

Ashleigh

Endless Possibilities with Infused Water

I normally have a hard time consuming enough water on a daily basis. With it being summertime, I wanted to make sure I drank enough so that I don’t get...

Professional Version

Commonly Searched Drugs

Recent News

PROCEDURES & EXAMS

Quizzes

Cases

Hepatic and Biliary Disorders

Approach to the Patient With Liver Disease