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Liver Diseases


									12.3 Liver Diseases

  Liver Cirrhosis

   Biliary Colic

Acute Cholecystitis

  Liver Abscess
• It is inflammation of the liver.
• The different types are:
  – Hepatitis A
  – Hepatitis B
  – Non-infectious Hepatitis
              Hepatitis A
• Caused by hepatitis virus.

•Spreads by the oral-fecal route.
             Hepatitis B
• Caused by hepatitis virus

• Spread by blood, body fluids, and
  sexual intercourse
     Non-infectious Hepatitis
• Causes:
  – Alcohol intoxication
  – Anti TB medications
  – HIV medications
  – Medications used to treat leprosy
      Signs and Symptoms
• Jaundice (gets worse for 2 weeks
  then slowly gets better)
• Malaise- generally feeling bad
       Signs and Symptoms
• Mild fever
• Loss of appetite
      Signs and Symptoms
• Nausea and vomiting
• Right upper quadrant
       Signs and Symptoms
• Smooth, tender and slightly enlarged
       Signs and Symptoms
• Dark urine and stools
• Check a liver function test in the
  laboratory- AST and ALT
• Check for specific liver antibodies
• Supportive treatment
• This means if the patient is
  dehydrated- give fluids, if in pain-
  give pain medicine
• Encourage the patient to drink and
  eat or give dextrose 5% IV
• NO alcohol
• Treat any primary infections
• Stop any medications that may be
  affecting their liver
• For Hepatitis A: improve sanitation
  – Clean water
  – Wash hands after using the bathroom
  – Keep toilet away from water used for
    cooking and cleaning
• For Hepatitis B: general precautions
  for health workers and vaccinations
  – Caution with dirty needles
  – Wearing glasses when things might
    splash into your eyes
  – Wearing gloves
• The best time to give a vaccine for
  Hepatitis B is:
  – At birth, 6 weeks, and 14 weeks of life
           Liver Cirrhosis
• Is a chronic disease that destroys the
  cells of the liver
• Causes scar tissue
• History of Hepatitis B or C virus
• Alcohol abuse
• Blood disorders
• Cirrhosis can lead to:
  – Liver failure
  – Encephalopathy
  – Hypoglycemia
  – Bleeding
  – Ascites
  – infections
      Signs and Symptoms
• Jaundice
• Malaise
      Signs and Symptoms
• Weakness
• Body Itching
       Signs and Symptoms
• Palms of the hands are red
• Slow hand tremor
      Signs and Symptoms
• Ascites
• Oedema of the legs
  and back
          Signs and Symptoms
• Enlarged spleen
• Gastrointestinal bleeding

   Normal spleen      Enlarged spleen
       Signs and Symptoms
• Muscle wasting
• Spider naevi: red spider-like blood
  vessels on the skin
• Check the liver function tests: AST
  and ALT
• Ultrasound the liver if possible
  – Does the liver have many nodules?
• There is no cure for cirrhosis
• There are ways to control the
  symptoms and to delay liver failure.
• Nutrition: patients need a high
  protein, low salt diet

• If there is gastrointestinal bleeding,
  give a blood transfusion and vitamin
  K 1 mg IM
• To prevent gastrointestinal bleeding,
  give omeprazole
• Watch their BP, too high might cause
• If there is oedema and ascites, give
  Spironalactone or Furosemide
• No more alcohol!
• No more medications that damage
  the liver (anti TB or leprosy
           Biliary Colic
• Severe abdominal pain caused by a
  stone going through a bile duct
• The stone blocks the bile duct and
  causes the patient to become
           Biliary Colic
• The blockage can be caused by
  gallstones and worms.
• It is very common to have gallstones
  during pregnancy.
       Signs and Symptoms
• Pain that comes in waves and
  radiates to back and right shoulder
• Guarding in right upper quadrant
      Signs and Symptoms
• Central abdominal pain moving to
  right upper quadrant
• Vomiting
      Signs and Symptoms
• No fever
• No jaundice
• Look at the patient, what are their
  signs and symptoms?
• Ultrasound of the gallbladder if
  possible. Are there stones?
• Buscopan IM or IV to stop the bile
  duct from spasming
• Pentazocine IM or SC for pain
• If there is still pain after two
  injections of buscopan/pentazocine
  ask a doctor for help
• Treat worms
• Regular deworming, especially in
  pregnant women
• A diet that is healthy and low in fat
        Acute cholecystitis
• A bacterial infection of the gall
  bladder mostly due to an obstruction
  of the gall ducts.
• It may happen after biliary colic
        Acute cholecystitis
• It may also be caused by
  malnourishment or typhoid fever.
       Signs and Symptoms
• Pain, tenderness, and guarding of the
  right upper quadrant
• vomiting
       Signs and Symptoms
• Fever, chills
• Jaundice
• Look at the patient. Do they have
  pain specifically in the right upper
  quadrant when touched but not in the
  left upper quadrant?
• Ultrasound the gallbladder. Is there
• Empyema: when the
  gallbladder fills with pus
• Peritonitis: inflammation
  of the membrane that lines
  the abdominal cavity
   Treatment of complications
• Bed rest
• Pain relief: buscopan IV or IM,
  codeine or tramadol
  Treatment of complications
• Nothing by mouth.
• Give IV fluids.
   Treatment of complications
• Ceftriaxone 1 gram IV daily and
  Metronidazole 500 mg IV three times
  a day until fever settles
• Then oral ciprofloxacin and
  metronidazole 500mg three times a
  day for 10 days.
   Treatment of complications
• Think about surgery to removed the
• Without surgery there is a 25%
  chance this will occur again.
• Surgically remove the gallbladder to
  prevent further attacks of
            Liver abscess
• A collection or collections of pus in
  the liver
• There are two types:
  – Amoebic
  – Bacterial
         Amoebic abscess
• Most common type of abscess
• The patient may have had a recent
  episode of dysentery
• Treat with metronidazole, with or
  without drainage.
         Bacterial abscess
• Mostly from bacteria ascending into
  the bile ducts
• The patient is often very sick
• Treat with broad spectrum
  antibiotics, with or without drainage
       Signs and Symptoms
• Fever and chills
• No appetite, nausea
       Signs and Symptoms
• Painful and enlarged liver
  (hepatomagely) on palpation or
• Sometimes chest pain with a right-
  sided pleural effusion
       Signs and Symptoms
• Usually there is no jaundice, no
  splenomegaly, and no ascites
• If those are present, think of other
• Look at the patient, what are their
• Ultrasound is very helpful is
  possible. Look for a pocket in the
• Test the stool. Are there amoebas?
• For a stable patient:
  – Start metronidazole orally
    • Child 7.5-10 mg/kg three times a day
    • Adult 750-800 mg three times a day
• If the patient improves, continue for
  14 days
• If patient is not improving after 3-5
  days, follow the unwell/septic
• For a unwell/septic patient:
  – Start IV ampicillin, gentamicin, and
    PO/IV metronidazole
  – Continue for 14 days, stop gentamicin
    after 8 days
• Some abscesses need to be drained
  with surgery.
• If they are greater than 6 cm and if
  the patient is not responding to
  antibiotic treatment
• Adequate and early treatment of
  amoebic dysentery could prevent a
  liver abscess.

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